Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN007635 | GA |
NPI | 1063560373 |
---|---|
Provider Name | Dr. Richard Davis Seaborn |
First Address | Decatur, GA 30035-4000 |
Second Address | Decatur, GA 30035-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |