Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 38074 | SC |
NPI | 1043539406 |
---|---|
Provider Name | David J Powell III |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29401-1113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 21/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380741 | (05) | SC |