Provider Demographics
NPI:1689712119
Name:SEIFERT, ALVIN RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:RONALD
Last Name:SEIFERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALVIN
Other - Middle Name:R
Other - Last Name:SEIFERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9757 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4167
Mailing Address - Country:US
Mailing Address - Phone:706-455-2490
Mailing Address - Fax:706-946-6574
Practice Address - Street 1:9757 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4167
Practice Address - Country:US
Practice Address - Phone:706-455-2490
Practice Address - Fax:706-946-6574
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB10489Medicare ID - Type Unspecified