Provider Demographics
NPI:1992568497
Name:SEIGFRED, THEODORA
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:SEIGFRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-1656
Mailing Address - Country:US
Mailing Address - Phone:706-846-8647
Mailing Address - Fax:706-846-3995
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1656
Practice Address - Country:US
Practice Address - Phone:706-846-8647
Practice Address - Fax:706-846-3775
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC057072183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician