Provider Demographics
NPI:1073374864
Name:SEYMOUR, CORDELL C
Entity Type:Individual
Prefix:
First Name:CORDELL
Middle Name:C
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 WOODWIND DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1994
Mailing Address - Country:US
Mailing Address - Phone:614-805-7928
Mailing Address - Fax:
Practice Address - Street 1:1151 WOODWIND DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1994
Practice Address - Country:US
Practice Address - Phone:614-226-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide