Provider Demographics
NPI:1255038469
Name:POWELL, ANNA HARALSON (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:HARALSON
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 CROSS CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-5304
Mailing Address - Country:US
Mailing Address - Phone:478-232-9361
Mailing Address - Fax:
Practice Address - Street 1:770 PINE ST STE 310
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7587
Practice Address - Country:US
Practice Address - Phone:478-741-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF02230367363LF0000X
GARN170006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily