Provider Demographics
NPI:1447251707
Name:SEELY, GEORGIA KANNON (MD)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:KANNON
Last Name:SEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:ANN
Other - Last Name:KANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 CONCOURSE BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5759
Mailing Address - Country:US
Mailing Address - Phone:804-549-4030
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:10710 MIDLOTHIAN TURNPIKE
Practice Address - Street 2:STE 401
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-794-2307
Practice Address - Fax:804-794-2944
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048279207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
785171OtherAETNA
070010579OtherRAILROAD MEDICARE
147157OtherSOUTHERN HEALTH
107147OtherANTHEM
0300119OtherUNITED HEALTHCARE
VA5900921Medicaid
147157OtherSOUTHERN HEALTH
107147OtherANTHEM