Provider Demographics
NPI:1851908446
Name:ASANTE-SELBY, JADE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:
Last Name:ASANTE-SELBY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 JIM MOORE RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1144
Mailing Address - Country:US
Mailing Address - Phone:770-339-0129
Mailing Address - Fax:
Practice Address - Street 1:3027 JIM MOORE RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1144
Practice Address - Country:US
Practice Address - Phone:770-339-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily