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General NPI Number Information
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NPI Number | 1750374476
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Entity Type | Individual
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Provider Name | CHARLES G SEWALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2005
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 800 OAK RIDGE TPKE SUITE C-100
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-483-2288
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Fax | 865-482-4400
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Provider Business Mailing Address
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Address Line | 800 OAK RIDGE TPKE SUITE C-100
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City | OAK RIDGE
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State | TN
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Zip | 37830-6957
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Country | US
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Telephone | 865-483-2288
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Fax | 865-482-4400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 28475
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 021441
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License Number State | TN
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