Provider Demographics
NPI:1750329595
Name:SOSEBEE, REBECCA CHASTEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CHASTEEN
Last Name:SOSEBEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 LANIER ISLANDS PARKWEY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1717
Mailing Address - Country:US
Mailing Address - Phone:770-932-9221
Mailing Address - Fax:
Practice Address - Street 1:4965 LANIER ISLANDS PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1700
Practice Address - Country:US
Practice Address - Phone:770-932-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA855567OtherBLUE CROSS
GA464068057AMedicaid
GA855567OtherBLUE CROSS
GA464068057AMedicaid