Provider Demographics
NPI:1760451363
Name:SOWELL, JONATHAN W (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:W
Last Name:SOWELL
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 1:1932 ALCOA HWY STE 255
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1508
Mailing Address - Country:US
Mailing Address - Phone:865-244-2030
Mailing Address - Fax:865-684-1196
Practice Address - Street 1:1932 ALCOA HWY STE 255
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1508
Practice Address - Country:US
Practice Address - Phone:865-244-2030
Practice Address - Fax:865-684-1196
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN010760207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0840230OtherUNITED HEALTHCARE
51366OtherBLUE CROSS BLUE SHIELD
180009849OtherRAILROAD MEDICARE
4038553OtherAETNA
100011900OtherPHP
0647640OtherUMWA
4207441OtherCIGNA
TN0104OtherJOHN DEERE
TN3006612Medicaid
TN0104OtherJOHN DEERE
100011900OtherPHP
4207441OtherCIGNA