Healthcare Provider Details

I. General information

NPI: 1568091585
Provider Name (Legal Business Name): LANDON SOWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

5924 HECKSHER DR
JACKSONVILLE FL
32226
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2000
  • Fax:
Mailing address:
  • Phone: 731-335-2822
  • Fax: 904-639-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS18813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: