Individual
KISA W SEYMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1025 N MAIN ST, CEDARTOWN, GA 30125-2036
(770) 748-0076
(770) 748-9323
Mailing address
420 E 2ND AVE, SUITE 103, ROME, GA 30161-3209
(706) 509-3000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4221
GA
207Q00000X
Family Medicine Physician
4221
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125281A
—
GA
Enumeration date
08/08/2006
Last updated
11/27/2023
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