Provider Demographics
NPI:1508833948
Name:SEABROOKS, KECHIA TANEKIA (ATC)
Entity Type:Individual
Prefix:MS
First Name:KECHIA
Middle Name:TANEKIA
Last Name:SEABROOKS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 MAHONIA PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4586
Mailing Address - Country:US
Mailing Address - Phone:770-322-0393
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:STE. 105
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-501-5144
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0011152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer