Individual
DR. MATTHEW R POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-5118
Mailing address
1120 15TH ST # BI-1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
81247
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
81247
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81247
GA MEDICAL LICENSE
GA
Enumeration date
06/26/2015
Last updated
04/27/2020
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