Provider Demographics
NPI:1316278666
Name:SEARS, VANESSA JOY (MT)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:JOY
Last Name:SEARS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10162 CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3603
Mailing Address - Country:US
Mailing Address - Phone:770-787-9055
Mailing Address - Fax:770-787-9054
Practice Address - Street 1:10162 CARLIN DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3603
Practice Address - Country:US
Practice Address - Phone:770-787-9055
Practice Address - Fax:770-787-9054
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006115173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist