MEDICARE: DR. DENETA H SELLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	58200	GA

General Provider Information

NPI Number	:	1114982998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENETA H SELLS MD

Provider Business Mailing Address
First Line	:	490 BILL KENNEDY WAY
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30316-6835
Country	:	US
Telephone Number	:	404-446-4726
Fax Number	:	404-446-4727

Provider Business Practice Location Address
First Line	:	490 BILL KENNEDY WAY
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30316-6835
Country	:	US
Telephone Number	:	404-446-4726
Fax Number	:	404-446-4727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	11/22/2011

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