Provider Demographics
NPI:1962664623
Name:SEABOLT, WESLEY N (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:N
Last Name:SEABOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 OLD THOMSON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-4407
Mailing Address - Country:US
Mailing Address - Phone:470-480-9512
Mailing Address - Fax:
Practice Address - Street 1:129 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3435
Practice Address - Country:US
Practice Address - Phone:706-896-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC338682084P0800X
UT8265410-12052084P0800X
KS04-360622084P0800X
GA642662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid