Healthcare Provider Details

I. General information

NPI: 1871674697
Provider Name (Legal Business Name): SEDMED PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TILGHMAN DR SUITE 722
DUNN NC
28334-0007
US

IV. Provider business mailing address

700 TILGHMAN DR SUITE 722
DUNN NC
28334-0007
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-1068
  • Fax: 910-892-4527
Mailing address:
  • Phone: 910-892-1068
  • Fax: 910-892-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29663
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number22319
License Number StateNC

VIII. Authorized Official

Name: JOHN MICHAEL SEDDON
Title or Position: OWNER
Credential: M.D.
Phone: 910-892-1068