MEDICARE: JOSEPH SEBASTIAN MD

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	207Q00000X	Family Medicine Physician	98309	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	35.141622	OH

General Provider Information

NPI Number	:	1992201495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SEBASTIAN MD

Provider Business Mailing Address
First Line	:	2908 BUSINESS 27
Second Line	:
City	:	BUCHANAN
State	:	GA
Zip	:	30113-4857
Country	:	US
Telephone Number	:	770-646-8281
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 BUSINESS 27
Second Line	:
City	:	BUCHANAN
State	:	GA
Zip	:	30113-4857
Country	:	US
Telephone Number	:	770-646-8281
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	06/14/2024

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