Provider Demographics
NPI:1083911630
Name:SEOK, REBECCA SUSAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUSAN
Last Name:SEOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 COLLIER ROAD
Mailing Address - Street 2:SUITE 5015
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-605-5699
Mailing Address - Fax:404-355-4235
Practice Address - Street 1:95 COLLIER ROAD
Practice Address - Street 2:SUITE 5015
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-605-5699
Practice Address - Fax:404-355-4235
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000541363LF0000X
GARN175608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I503384Medicare PIN