Provider Demographics
NPI:1235837253
Name:SEELHAMMER, AVERY (FNP)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:SEELHAMMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DAHLONEGA ST STE B103
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2482
Mailing Address - Country:US
Mailing Address - Phone:762-303-0034
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA ST STE B103
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2482
Practice Address - Country:US
Practice Address - Phone:706-303-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057776876OtherGEORGIA DRIVER'S LICENSE