1699090720 NPI number — MR. HENRY J SEWELL JR.

Table of content: MR. HENRY J SEWELL JR. (NPI 1699090720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699090720 NPI number — MR. HENRY J SEWELL JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEWELL
Provider First Name:
HENRY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699090720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 GLEN EAGLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-6920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-4580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 HONEYSUCKLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-4289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-836-0890
Provider Business Practice Location Address Fax Number:
334-836-0894
Provider Enumeration Date:
03/31/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7200 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7200 . This is a "STATE OF ALABAMA LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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