Provider Demographics
NPI:1043045230
Name:SEABOLT, SARAH VAIL
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:VAIL
Last Name:SEABOLT
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 1:627 MOUNTAIN TOPS RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-7573
Mailing Address - Country:US
Mailing Address - Phone:706-851-4895
Mailing Address - Fax:
Practice Address - Street 1:4920 ROSWELL RD STE 19
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2636
Practice Address - Country:US
Practice Address - Phone:404-224-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA303710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner