Provider Demographics
NPI:1407231897
Name:SEABOLT, DAVID II
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SEABOLT
Suffix:II
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 1:7610 OLD SADDLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-8902
Mailing Address - Country:US
Mailing Address - Phone:678-887-5901
Mailing Address - Fax:
Practice Address - Street 1:3867 ROSWELL RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4452
Practice Address - Country:US
Practice Address - Phone:678-904-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02492363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical