Individual provider Active NPI

Dmitry Y Sereda, D.C.

  • Chiropractor
  • Atlanta, GA
National Provider Identifier
1245312909
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06983 Issued in GA
Practice address
855 Mount Vernon Hwy NE Ste 100
Atlanta, GA 30328-4281
Phone
(770) 394-1336
Fax
(770) 394-1337
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 06983 GA Primary

Addresses

Primary practice location

855 Mount Vernon Hwy NE Ste 100
Atlanta, GA 30328-4281

Mailing address

855 Mt. Vernon Hwy. NE, Suite 100
Suite 100
Atlanta, GA 30328-4403
Phone (770) 394-1336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050118000518 GA Practitioner - Chiropractic 1052360906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

855 Mount Vernon Hwy NE
Suite 100
Atlanta, GA 30328-4281

855 Mt Vernon Hwy NE 100
Atlanta, GA 30328-4244
Phone (770) 394-1336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06983GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Total Wellness Chiropractor CurrentSince Aug 22, 2003 Accepting new patients

Locations

855 Mount Vernon Hwy NE
Ste 100
Sandy Springs, GA 30328
Phone (770) 394-1336

855 Mount Vernon Hwy NE
Sandy Springs, GA 30328
Phone (770) 394-1336

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1245312909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 MT. VERNON HWY. NE, SUITE 100",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284403",
            "telephone_number": "770-394-1336",
            "fax_number": "770-394-1337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MOUNT VERNON HWY NE STE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284281",
            "telephone_number": "770-394-1336",
            "fax_number": "770-394-1337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEREDA",
        "first_name": "DMITRY",
        "middle_name": "Y",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "06983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.