Healthcare Provider Details

I. General information

NPI: 1730619461
Provider Name (Legal Business Name): HEATHER ANN SEWELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

IV. Provider business mailing address

2007 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-9390
  • Fax: 706-866-4740
Mailing address:
  • Phone: 706-861-9390
  • Fax: 706-866-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN052831
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: