Healthcare Provider Details

I. General information

NPI: 1275012015
Provider Name (Legal Business Name): LISA J SELLERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 WHEAT AVE
BAINBRIDGE GA
39819
US

IV. Provider business mailing address

454 SMITH AVE
THOMASVILLE GA
31792-5535
US

V. Phone/Fax

Practice location:
  • Phone: 229-416-4421
  • Fax: 229-416-4644
Mailing address:
  • Phone: 229-584-2540
  • Fax: 229-226-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9299705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: