Provider Demographics
NPI:1669679114
Name:ENNIS, ERIN KATHERINE POWELL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHERINE POWELL
Last Name:ENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHERINE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 POOLE DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-5207
Practice Address - Country:US
Practice Address - Phone:919-779-1440
Practice Address - Fax:919-662-0613
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141387OtherRTL
NC5915370Medicaid
NCNC5153AMedicare PIN