Healthcare Provider Details

I. General information

NPI: 1063472876
Provider Name (Legal Business Name): JOHN C. SOWELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

105 NORLIN DR
GREENVILLE SC
29607-6615
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9744
  • Fax: 706-723-0205
Mailing address:
  • Phone: 864-890-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDNGA000207
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0222
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN008224
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2139
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: