MEDICARE: SOWELL PSYCH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1447141791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOWELL PSYCH SERVICES LLC

Provider Business Mailing Address
First Line	:	5991 WAKULLA SPRINGS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 RICHARD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-7328
Country	:	US
Telephone Number	:	731-335-2822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LANDON SOWELL
Credential	:	DO
Telephone Number	:	731-335-2822

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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