Provider Demographics
NPI:1386311074
Name:OWEN, SETH SHELDON (NP)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:SHELDON
Last Name:OWEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 SHIELDS RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5069
Mailing Address - Country:US
Mailing Address - Phone:706-278-6628
Mailing Address - Fax:
Practice Address - Street 1:1933 SHIELDS RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5069
Practice Address - Country:US
Practice Address - Phone:706-278-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248530363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics