Healthcare Provider Details

I. General information

NPI: 1952228041
Provider Name (Legal Business Name): COLLIN ODANE SEWELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 PIEDMONT RD NE APT 3505
ATLANTA GA
30324-3452
US

IV. Provider business mailing address

2323 PIEDMONT RD NE APT 3505
ATLANTA GA
30324-3452
US

V. Phone/Fax

Practice location:
  • Phone: 718-675-6054
  • Fax:
Mailing address:
  • Phone: 718-675-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIRO11401
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO11401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: