Provider Demographics
NPI:1194184879
Name:DUCASSE, SEQUIOA (DPM)
Entity Type:Individual
Prefix:
First Name:SEQUIOA
Middle Name:
Last Name:DUCASSE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 206
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8654
Mailing Address - Country:US
Mailing Address - Phone:404-833-3969
Mailing Address - Fax:404-228-9892
Practice Address - Street 1:2550 WINDY HILL RD SE STE 206
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8654
Practice Address - Country:US
Practice Address - Phone:404-833-3969
Practice Address - Fax:404-228-9892
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR372213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery