Provider Demographics
NPI:1487604849
Name:SEQUEIRA, JUDY H (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:H
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:488 KENNESAW AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9409
Practice Address - Country:US
Practice Address - Phone:404-885-7701
Practice Address - Fax:404-885-7777
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA042118207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000866929FMedicaid
GA22BDDBVOtherMEDICARE
GA000866929FMedicaid
GA511I220025Medicare PIN