Provider Demographics
NPI:1013633890
Name:MAYO, SEBRINA
Entity Type:Individual
Prefix:MS
First Name:SEBRINA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3899 KITTERY PT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3125
Mailing Address - Country:US
Mailing Address - Phone:803-586-7241
Mailing Address - Fax:
Practice Address - Street 1:2341 HENRY CLOWER BLVD STE D
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7420
Practice Address - Country:US
Practice Address - Phone:470-506-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician