Healthcare Provider Details

I. General information

NPI: 1215094966
Provider Name (Legal Business Name): DONDRAIE LALETA SEAY BACHELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONDRAIE LALETA SEAY BACHELOR'S

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 S CLAY ST
QUITMAN GA
31643-3505
US

IV. Provider business mailing address

1409 S CLAY ST
QUITMAN GA
31643-3505
US

V. Phone/Fax

Practice location:
  • Phone: 229-560-4382
  • Fax: 866-484-8285
Mailing address:
  • Phone: 229-560-4382
  • Fax: 866-484-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number4547
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: