# SEWANEE FAMILY PRACTICE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063817625
- **Authorized official:** LOUIS E KOELLA MD (PRESIEDENT)
- **Authorized official phone:** (931) 598-5648

## Contact information

- **Practice address:** 1314 UNIVERSITY AVE, SEWANEE, TN 37375-2336
- **Practice address phone:** (931) 598-5648
- **Practice address fax:** (931) 598-0778
- **Mailing address:** PO BOX 700, SEWANEE, TN 37375-0700
- **Mailing address phone:** (931) 598-5648
- **Mailing address fax:** (931) 598-0778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1376 | TN | — |
| 207Q00000X | Family Medicine Physician | 34975 | TN | Yes |
| 207Q00000X | Family Medicine Physician | 713 | TN | — |

## Other

- **Enumeration date:** 10/24/2014
- **Last updated:** 10/24/2014