Healthcare Provider Details

I. General information

NPI: 1720071269
Provider Name (Legal Business Name): WILLIAM M SEWELL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

IV. Provider business mailing address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-7010
  • Fax: 229-903-1585
Mailing address:
  • Phone: 229-883-7010
  • Fax: 229-903-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: