Provider Demographics
NPI:1750374476
Name:SEWALL, CHARLES G (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:SEWALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-483-2288
Mailing Address - Fax:865-482-4400
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:SUITE C-100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-483-2288
Practice Address - Fax:865-482-4400
Is Sole Proprietor?:No
Enumeration Date:2005-08-28
Last Update Date:2023-05-17
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Provider Licenses
StateLicense IDTaxonomies
KY28475207YX0007X
TN021441207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN62089728903OtherUHC RIVER VALLEY
KY000000252844OtherANTHEM BLUE CROSS
TN100020676OtherPHP TENNCARE
TN3059927Medicaid
KY620897289002OtherBLUEGRASS
TN4666257OtherAETNA
KYC10003OtherCUMBERLAND HEALTHCARE
KY64799125Medicaid
TN3028800OtherBLUE CROSS BLUE SHIELD
KY4532OtherCHA
KY0246303Medicare ID - Type Unspecified
KY64799125Medicaid