Provider Demographics
NPI:1801890694
Name:POWELL, TIMOTHY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
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 1:140 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1726
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:
Practice Address - Street 1:222 W 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2413
Practice Address - Country:US
Practice Address - Phone:931-783-4269
Practice Address - Fax:931-372-0401
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31584208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4256820OtherBCBS
KY7100155930Medicaid
TNQ031095Medicaid
TN4256820OtherBCBS
H31156Medicare UPIN
H31156Medicare UPIN
780001924Medicare PIN
TN124013OtherUNISON TENNCARE
AR142939001Medicaid
TN3861349Medicaid