Provider Demographics
NPI:1265631865
Name:SEAGO, RICHARD WINSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WINSTON
Last Name:SEAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 PECAN ST S
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1917
Mailing Address - Country:US
Mailing Address - Phone:770-537-4606
Mailing Address - Fax:770-537-4000
Practice Address - Street 1:613 PECAN ST S
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-1917
Practice Address - Country:US
Practice Address - Phone:770-537-4606
Practice Address - Fax:770-537-4000
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD41082Medicare UPIN