Provider Demographics
NPI:1275012015
Name:SELLERS, LISA J (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:SELLERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5535
Mailing Address - Country:US
Mailing Address - Phone:229-584-2540
Mailing Address - Fax:229-226-2036
Practice Address - Street 1:509 WHEAT AVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819
Practice Address - Country:US
Practice Address - Phone:229-416-4421
Practice Address - Fax:229-416-4644
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299705363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner