Provider Demographics
NPI:1720304520
Name:SEAL, KATHRYN ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:SEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 ALEXANDER RD NE
Mailing Address - Street 2:APT #456
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-4244
Mailing Address - Country:US
Mailing Address - Phone:770-906-8228
Mailing Address - Fax:
Practice Address - Street 1:3410 ALEXANDER RD NE
Practice Address - Street 2:APT #456
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-4244
Practice Address - Country:US
Practice Address - Phone:770-906-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
GA069254207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program