=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447251707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGIA KANNON SEELY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10800 MIDLOTHIAN TPKE STE 309
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-4796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-549-4030
-----------------------------------------------------
Fax | 804-549-4032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7201 GLEN FOREST DR STE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23226-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-549-4030
-----------------------------------------------------
Fax | 804-549-4032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 0101048279
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------