Provider Demographics
NPI:1649372343
Name:KING, SEBORAH WILLIAMS (OD)
Entity type:Individual
Prefix:DR
First Name:SEBORAH
Middle Name:WILLIAMS
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1005 UNDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-3332
Mailing Address - Country:US
Mailing Address - Phone:478-737-6286
Mailing Address - Fax:478-477-9149
Practice Address - Street 1:5955 ZEBULON RD
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2030
Practice Address - Country:US
Practice Address - Phone:478-477-9011
Practice Address - Fax:478-471-9042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist