MEDICARE: MS. SHARON E SEAGO BC-HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HADSOOO220	GA

General Provider Information

NPI Number	:	1417221896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON E SEAGO BC-HIS

Provider Business Mailing Address
First Line	:	2655 N DECATUR RD STE D
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6100
Country	:	US
Telephone Number	:	404-373-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 N DECATUR RD STE D
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6100
Country	:	US
Telephone Number	:	404-373-2411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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