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Charles Powell

Physician Assistant in Daytona Beach, FL. Individual provider (NPI-1).

NPI number1295100717
StatusActive
Last updated in NPPESApr 8, 2021

Details

NPI
1295100717
Entity type
Individual (NPI-1)
Name
Charles Powell
Sex
Male
Sole proprietor
Yes
Enumeration date
Dec 9, 2015
Certification date
Apr 8, 2021
Last updated
Apr 8, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant––Yes

Practice location

545 Health Blvd
Daytona Beach, FL 32114-1493

Phone 386-239-8500

Mailing address

12109 County Road 103
Oxford, FL 34484-2951

Phone 352-205-8981

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