Provider Demographics
NPI:1902239064
Name:DAVIDRANDALSEALEMDPLLC
Entity Type:Organization
Organization Name:DAVIDRANDALSEALEMDPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-690-4050
Mailing Address - Street 1:8870 CEDAR SPRINGS LN
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5407
Mailing Address - Country:US
Mailing Address - Phone:865-690-4050
Mailing Address - Fax:865-690-0720
Practice Address - Street 1:8870 CEDAR SPRINGS LN
Practice Address - Street 2:SUITE 209
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5407
Practice Address - Country:US
Practice Address - Phone:865-690-4050
Practice Address - Fax:865-690-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN315182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853991Medicaid
TNF74973Medicare UPIN