Healthcare Provider Details

I. General information

NPI: 1801524434
Provider Name (Legal Business Name): TERRI SEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 VICTORIA LN
ATLANTA GA
30354-1549
US

IV. Provider business mailing address

221 VICTORIA LN
ATLANTA GA
30354-1549
US

V. Phone/Fax

Practice location:
  • Phone: 850-708-3104
  • Fax: 770-723-8870
Mailing address:
  • Phone: 850-708-3104
  • Fax: 770-723-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN128832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: