1649372343 NPI number — DR. SEBORAH WILLIAMS KING O.D.

Table of content: DR. SEBORAH WILLIAMS KING O.D. (NPI 1649372343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649372343 NPI number — DR. SEBORAH WILLIAMS KING O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
SEBORAH
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1649372343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 UNDERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31210-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-737-6286
Provider Business Mailing Address Fax Number:
478-477-9149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5955 ZEBULON RD
Provider Second Line Business Practice Location Address:
WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-477-9011
Provider Business Practice Location Address Fax Number:
478-471-9042
Provider Enumeration Date:
09/02/2006

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: 152W00000X , with the licence number:  OPT001942 , 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)





Copyright © 2007-2025 www.npivalidator.com