Provider Demographics
NPI:1164461786
Name:POWELL, ALVIN C (MD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:C
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3654
Mailing Address - Country:US
Mailing Address - Phone:336-379-9708
Mailing Address - Fax:336-379-8714
Practice Address - Street 1:309 NEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3654
Practice Address - Country:US
Practice Address - Phone:336-379-9708
Practice Address - Fax:336-379-8714
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39320207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2487OtherPARTNERS
NC65635OtherBCBS PROVIDER #
NC390004562OtherRRM PROVIDER #
NC896835Medicaid
NC561274347OtherCKA'S PROVIDER #
NC3100691OtherUHC PROVIDER #
NC1249666Medicare PIN
NCD56780Medicare UPIN