Healthcare Provider Details

I. General information

NPI: 1154061232
Provider Name (Legal Business Name): LILIANA GENTA SEABOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 FORD AVE STE 3A
RICHMOND HILL GA
31324-3972
US

IV. Provider business mailing address

10055 FORD AVE STE 3A
RICHMOND HILL GA
31324-3972
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-9601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116036527
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number114447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: