Provider Demographics
NPI:1891843314
Name:SELLERS, JOSEPH DAVIS JR (RD, LD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVIS
Last Name:SELLERS
Suffix:JR
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1855
Mailing Address - Country:US
Mailing Address - Phone:334-688-7000
Mailing Address - Fax:334-688-7127
Practice Address - Street 1:820 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1855
Practice Address - Country:US
Practice Address - Phone:334-688-7000
Practice Address - Fax:334-688-7127
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-35790OtherBC OF AL PROVIDER NUMBER