Provider Demographics
NPI:1598705071
Name:SEWELL, JEFFERY K (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:K
Last Name:SEWELL
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 1:408 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3237
Mailing Address - Country:US
Mailing Address - Phone:678-796-0804
Mailing Address - Fax:678-796-0805
Practice Address - Street 1:408 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3237
Practice Address - Country:US
Practice Address - Phone:678-796-0804
Practice Address - Fax:678-796-0805
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042723207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG31367Medicare UPIN