Provider Demographics
NPI:1821193046
Name:SELLERS-SCOTT, ADRENE (MD)
Entity Type:Individual
Prefix:
First Name:ADRENE
Middle Name:
Last Name:SELLERS-SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MEDICAL WAY STE B1
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2533
Mailing Address - Country:US
Mailing Address - Phone:770-909-4449
Mailing Address - Fax:770-909-6277
Practice Address - Street 1:150 MEDICAL WAY STE B1
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2533
Practice Address - Country:US
Practice Address - Phone:770-909-4449
Practice Address - Fax:770-909-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA894980142CMedicaid
GA894980142CMedicaid