Provider Demographics
NPI:1275864068
Name:GJONE, MANDY SELLERS (NP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:SELLERS
Last Name:GJONE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:704 MAPLE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7221
Mailing Address - Country:US
Mailing Address - Phone:912-538-0523
Mailing Address - Fax:912-538-8945
Practice Address - Street 1:704 MAPLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7221
Practice Address - Country:US
Practice Address - Phone:912-538-0523
Practice Address - Fax:912-538-8945
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN137168NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily