Basic Information
| Provider Information | |||||||||
| NPI: | 1790723450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEWELL | ||||||||
| FirstName: | CONSTANCE | ||||||||
| MiddleName: | JONES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 571 S ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | FLAT ROCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287319447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286926178 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 571 S ALLEN RD | ||||||||
| Address2: | |||||||||
| City: | FLAT ROCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287319447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286926178 | ||||||||
| FaxNumber: | 8283563998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38787 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | 38787 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8946924 | 05 | NC | MEDICAID | 38787 | 01 | NC | MEDICAL DOCTOR | OTHER | BJ2249630 | 01 | NC | DEA | OTHER | XJ2249630 | 01 | NC | DEA | OTHER |