Healthcare Provider Details

I. General information

NPI: 1801229695
Provider Name (Legal Business Name): MICHAEL DAVID SEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GRIFFIN MILL RD
EASLEY SC
29640-6929
US

IV. Provider business mailing address

1400 GRIFFIN MILL RD
EASLEY SC
29640-6929
US

V. Phone/Fax

Practice location:
  • Phone: 864-397-1059
  • Fax: 864-859-1779
Mailing address:
  • Phone: 864-397-1059
  • Fax: 864-859-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: