Provider Demographics
NPI:1982925202
Name:SEQUOIA, JACQUELINE (MD, MPH, MAS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SEQUOIA
Suffix:
Gender:F
Credentials:MD, MPH, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 AIKEN MALL DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7689
Mailing Address - Country:US
Mailing Address - Phone:803-648-1464
Mailing Address - Fax:803-649-2027
Practice Address - Street 1:340 EXCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1759
Practice Address - Country:US
Practice Address - Phone:706-413-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067438208M00000X, 207Q00000X
SC34378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist