MEDICARE: HARRY EDDIE SEYMOUR

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	103TB0200X	Cognitive & Behavioral Psychologist	000000000	NC

General Provider Information

NPI Number	:	1790571537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY EDDIE SEYMOUR

Provider Business Mailing Address
First Line	:	PO BOX 690670
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7012
Country	:	US
Telephone Number	:	704-957-4722
Fax Number	:	704-706-2629

Provider Business Practice Location Address
First Line	:	4700 LEBANON RD STE A3
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-8265
Country	:	US
Telephone Number	:	704-957-4722
Fax Number	:	704-706-2629

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

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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