Provider Demographics
NPI:1669676755
Name:SELLS, GREGORY M
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:M
Last Name:SELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15340-A COUNTY ROAD 66
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-4130
Mailing Address - Country:US
Mailing Address - Phone:251-964-8900
Mailing Address - Fax:251-964-8901
Practice Address - Street 1:15340A COUNTY ROAD 66
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-4130
Practice Address - Country:US
Practice Address - Phone:251-964-8900
Practice Address - Fax:251-964-8901
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL335E00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000680OtherAL STATE BOARD OF PHARMAC
AL765OtherAL BOARD OF HME SERVICES
AL9112OtherAL STATE LICENSE
AL000680OtherAL STATE BOARD OF PHARMAC