Provider Demographics
NPI:1245312909
Name:SEREDA, DMITRY Y (DC)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:Y
Last Name:SEREDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 MT. VERNON HWY. NE, SUITE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4403
Mailing Address - Country:US
Mailing Address - Phone:770-394-1336
Mailing Address - Fax:770-394-1337
Practice Address - Street 1:855 MOUNT VERNON HWY NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4281
Practice Address - Country:US
Practice Address - Phone:770-394-1336
Practice Address - Fax:770-394-1337
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU96523Medicare UPIN
GA35ZCHKDMedicare ID - Type UnspecifiedMEDICARE