Provider Demographics
NPI:1417221896
Name:SEAGO, SHARON E (BC-HIS)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:E
Last Name:SEAGO
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 N DECATUR RD STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6100
Mailing Address - Country:US
Mailing Address - Phone:404-373-2411
Mailing Address - Fax:
Practice Address - Street 1:2655 N DECATUR RD STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6100
Practice Address - Country:US
Practice Address - Phone:404-373-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADSOOO220237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist