Healthcare Provider Details

I. General information

NPI: 1275969024
Provider Name (Legal Business Name): JESSIE MAE SEWARD D.C., L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 ROBINSON RD NE STE C
MARIETTA GA
30068-2289
US

IV. Provider business mailing address

2231 ROBINSON RD NE STE C
MARIETTA GA
30068-2289
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-5775
  • Fax: 770-973-2257
Mailing address:
  • Phone: 770-973-5775
  • Fax: 770-973-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR002622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: