Healthcare Provider Details

I. General information

NPI: 1992159503
Provider Name (Legal Business Name): JOSEPH THOMAS SEAGRAVES JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 18TH ST E
TIFTON GA
31794-3648
US

IV. Provider business mailing address

907 18TH ST E STE 400
TIFTON GA
31794-3684
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-7120
  • Fax:
Mailing address:
  • Phone: 229-353-3422
  • Fax: 229-353-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP193158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: