Individual
JERRY LAMON POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-8383
(336) 718-9622
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 564-4866
(336) 564-4869
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0099-00991
NC
208M00000X
Hospitalist Physician
Primary
9900991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110245714
RR MEDICARE
NC
05
—
891238C
—
NC
Enumeration date
07/07/2006
Last updated
05/12/2021
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