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General NPI Number Information
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NPI Number | 1215631981
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Entity Type | Individual
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Provider Name | JIMMY ANDREW SELLERS APRN FNP C
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Gender | Male
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 462 ELMA G MILES PKWY
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City | HINESVILLE
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State | GA
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Zip | 31313-4000
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Country | US
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Telephone | 912-369-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S MADISON ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-5473
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Country | US
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Telephone | 229-236-0831
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Fax | 229-236-0871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN239497
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License Number State | GA
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