Provider Demographics
NPI:1093853756
Name:SELBY, JUNE ELLEN (CNM)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:ELLEN
Last Name:SELBY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:JUNE
Other - Middle Name:ELLEN
Other - Last Name:EMRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:OB CLINIC
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7694
Practice Address - Country:US
Practice Address - Phone:678-312-4616
Practice Address - Fax:770-682-2251
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100226367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife