Provider Demographics
NPI:1033274956
Name:SEAY, WALLACE JAKE JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:JAKE
Last Name:SEAY
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8160 WALL TRIANA HWY
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-8869
Mailing Address - Country:US
Mailing Address - Phone:256-653-5967
Mailing Address - Fax:
Practice Address - Street 1:700 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2457
Practice Address - Country:US
Practice Address - Phone:256-233-9151
Practice Address - Fax:256-216-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL17956207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG10030Medicare UPIN