Healthcare Provider Details

I. General information

NPI: 1740266055
Provider Name (Legal Business Name): STEPHEN W SEWARD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 MAGNOLIA WAY
AUGUSTA GA
30909-9481
US

IV. Provider business mailing address

1706 MAGNOLIA WAY
AUGUSTA GA
30909-9481
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-7529
  • Fax: 706-312-7613
Mailing address:
  • Phone: 706-210-7529
  • Fax: 706-312-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1136638
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT010926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: