Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | AL5548 | AL |
NPI | 1093034514 |
---|---|
Provider Name | Dr. Adam Powell |
First Address | Tuscaloosa, AL 35404-2902 |
Second Address | Tuscaloosa, AL 35404-2902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 03/01/2012 |