Organization
PO POWELL MANAGEMENT GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYANNA JOHNSON FNP-C (OWNER)
(910) 552-1580
Entity
Organization
Contact information
Practice address
112 MEDICAL VILLAGE DR STE F, WALLACE, NC 28466-1665
(910) 665-1780
(910) 665-1780
Mailing address
4350 NC HWY 11, WILLARD, NC 28478-7006
(910) 552-1580
(910) 665-1780
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/02/2021
Last updated
07/02/2021
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