Individual
MR. TIMOTHY A POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
517 MOYE BLVD, GREENVILLE, NC 27834-2849
(252) 744-0766
(252) 744-0392
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101049447
VA
207R00000X
Internal Medicine Physician
2017-00518
NC
208000000X
Pediatrics Physician
Primary
2017-00518
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010254558
—
VA
05
—
1699879924
—
NC
01
—
19RGP
BCBS OF NC
NC
01
—
461276
ANTHEM
VA
01
—
NCX793022
MEDICARE
NC
Enumeration date
09/08/2006
Last updated
02/28/2024
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