Provider Demographics
NPI:1700836145
Name:SEWELL, CHARLES WHITAKER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WHITAKER
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 1:1364 CLIFTON RD NE
Mailing Address - Street 2:EMORY UNIVERSITY HOSPITAL, STE. H185C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-712-7003
Mailing Address - Fax:404-727-2519
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:EMORY UNIVERSITY HOSPITAL, STE. H185C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-7003
Practice Address - Fax:404-727-2519
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013239207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE72622Medicare UPIN