1609137827 NPI number — DR. JEREMY MICHAEL SEDLOCK D.C.

Table of content: DR. JEREMY MICHAEL SEDLOCK D.C. (NPI 1609137827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609137827 NPI number — DR. JEREMY MICHAEL SEDLOCK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEDLOCK
Provider First Name:
JEREMY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609137827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3338 PEACHTREE RD NE APT 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30326-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-787-6941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9700 MEDLOCK BRIDGE RD
Provider Second Line Business Practice Location Address:
STE 132
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-450-9394
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR008982 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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