Healthcare Provider Details

I. General information

NPI: 1962457481
Provider Name (Legal Business Name): SHOANMARIE SEALS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 INDUSTRIAL BLVD NE STE J
COVINGTON GA
30014
US

IV. Provider business mailing address

10255 INDUSTRIAL BLVD NE STE J
COVINGTON GA
30014
US

V. Phone/Fax

Practice location:
  • Phone: 678-418-3400
  • Fax: 678-418-3444
Mailing address:
  • Phone: 678-418-3400
  • Fax: 678-418-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number7129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: