Individual
DR. CLARENCE LESLIE POWELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 FAIRVIEW DR, SUITE B, FRANKLIN, VA 23851-1226
(757) 562-2158
(757) 562-2134
Mailing address
102 FAIRVIEW DR, SUITE B, FRANKLIN, VA 23851-1226
(757) 562-2158
(757) 562-2134
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101027857
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005666805
—
VA
01
—
0101027857
STATE MEIDCAL LICENSE
VA
Enumeration date
02/03/2006
Last updated
05/17/2010
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