Healthcare Provider Details

I. General information

NPI: 1851102891
Provider Name (Legal Business Name): SETH MATTHEW O'STEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TUGGLE RD
CAIRO GA
39827-9998
US

IV. Provider business mailing address

101 TUGGLE RD
CAIRO GA
39827-9998
US

V. Phone/Fax

Practice location:
  • Phone: 229-201-2025
  • Fax:
Mailing address:
  • Phone: 229-201-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: