Healthcare Provider Details

I. General information

NPI: 1942506746
Provider Name (Legal Business Name): SHERITA SEWARD-BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 35200 OPTICAL CENTER
FORT GORDON GA
30905
US

IV. Provider business mailing address

BUILDING 35200 OPTICAL CENTER
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-771-9403
  • Fax:
Mailing address:
  • Phone: 706-771-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002623
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: