Provider Demographics
NPI:1871599332
Name:SEBELIK, MERRY ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MERRY
Middle Name:ELLEN
Last Name:SEBELIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-727-9610
Mailing Address - Fax:404-712-1540
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1135
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-727-9610
Practice Address - Fax:404-712-1540
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31659207Y00000X
FLME97014207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00380951OtherRAILROAD MEDICARE
FL56616OtherBCBS
FLP00380951OtherRAILROAD MEDICARE
FLU8518ZMedicare PIN
E86877Medicare UPIN
AR5M830Medicare PIN