Provider Demographics
NPI:1598804197
Name:SELESKA, DEBRA M (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:SELESKA
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 1:920 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:229-227-5500
Mailing Address - Fax:229-227-5505
Practice Address - Street 1:907 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643
Practice Address - Country:US
Practice Address - Phone:229-263-4531
Practice Address - Fax:229-263-5787
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBLBBMedicare PIN
P34247Medicare UPIN