Provider Demographics
NPI:1417295270
Name:SELLERS, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2352
Mailing Address - Country:US
Mailing Address - Phone:770-314-5635
Mailing Address - Fax:
Practice Address - Street 1:331 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2352
Practice Address - Country:US
Practice Address - Phone:770-314-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator