PO Powell Management Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PO POWELL MANAGEMENT GROUP, LLC

Practice address

112 Medical Village Dr Ste F
Wallace, NC 28466-1665

Phone

(910) 665-1780

Fax

(910) 665-1780

NPI assigned

Jul 2, 2021

Last updated

Jul 2, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maryanna Johnson, FNP-C

Title

Owner

Phone

(910) 552-1580

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1760053581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 NC HWY 11",
            "city": "WILLARD",
            "state": "NC",
            "postal_code": "284787006",
            "telephone_number": "910-552-1580",
            "fax_number": "910-665-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL VILLAGE DR STE F",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284661665",
            "telephone_number": "910-665-1780",
            "fax_number": "910-665-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PO POWELL MANAGEMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARYANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-552-1580",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "server",
            "affiliation": "N",
            "address_1": "112 Medical Village Dr Ste F",
            "city": "Wallace",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284661665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrea Perkins, COTA/L
• Horace Vernon Pigford III, PT
• Horace Vernon Pigford Jr., PT
• Kathleen B Pigford, SPEECH PATHOLOGIST
• Pigfords Physical Therapy Assoc Inc
• Carlie Powell
• Megan Carlton Powell, DPT
• Dametri Pratt
• Premise Health of North Carolina Medical PC (House of Raeford Health & Wellness Center)
• Lauren Prentice, PHARMD

• Internal Medicine Physician in Wallace, NC
• Providers in Wallace, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.