Provider Demographics
NPI:1427094804
Name:SEAGRAVES, MARCIA FEARS (PT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:FEARS
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 GRAMERCY HILLS LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7249
Mailing Address - Country:US
Mailing Address - Phone:404-626-6071
Mailing Address - Fax:
Practice Address - Street 1:880 GRAMERCY HILLS LN
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7249
Practice Address - Country:US
Practice Address - Phone:404-626-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0068062251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52153474001OtherAUSTELL LOCATION
GA52153474002OtherBCBS MARIETTA LOCATION
GA52153474003OtherBCBS WOODSTOCK LOCATION
GA52153474004OtherBCBS DOUGLASVILLE LOCATIO
GA52153474004OtherBCBS DOUGLASVILLE LOCATIO
GAQ46976Medicare UPIN