Provider Demographics
NPI:1790170272
Name:SEYMOUR, YETREVIAS (NP-C)
Entity type:Individual
Prefix:
First Name:YETREVIAS
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SPRINGWATER SHRS
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3822
Mailing Address - Country:US
Mailing Address - Phone:678-877-2100
Mailing Address - Fax:
Practice Address - Street 1:20 SPRINGWATER SHRS
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3822
Practice Address - Country:US
Practice Address - Phone:678-877-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily