Provider Demographics
NPI:1861683989
Name:RODDENBERY, SEABORN A V (MD)
Entity Type:Individual
Prefix:MR
First Name:SEABORN
Middle Name:A
Last Name:RODDENBERY
Suffix:V
Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 10TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3600
Mailing Address - Country:US
Mailing Address - Phone:706-984-7400
Mailing Address - Fax:706-984-7401
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-984-7400
Practice Address - Fax:706-984-7401
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA063806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA675260995Medicaid
LA1067717Medicaid
AL148772Medicaid
GA202I024575OtherMEDICARE PTAN