Healthcare Provider Details

I. General information

NPI: 1215584198
Provider Name (Legal Business Name): JULIE B SEWELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE B SEWELL JULIE B. SEWELL NP-C

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TECHNOLOGY PKWY S STE 300
NORCROSS GA
30092-2924
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 800-226-8874
  • Fax:
Mailing address:
  • Phone: 800-226-8874
  • Fax: 877-366-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN127340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: