Healthcare Provider Details

I. General information

NPI: 1497441208
Provider Name (Legal Business Name): JENNA R SEAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10545 COLERAIN RD.
KINGSLAND GA
31548
US

IV. Provider business mailing address

10545 COLERAIN RD.
KINGSLAND GA
31548
US

V. Phone/Fax

Practice location:
  • Phone: 912-266-8686
  • Fax:
Mailing address:
  • Phone: 912-266-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: