Provider Demographics
NPI:1275864068
Name:GJONE, MANDY SELLERS (NP)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:SELLERS
Last Name:GJONE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CITY CIRCLE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7059
Mailing Address - Country:US
Mailing Address - Phone:912-705-6653
Mailing Address - Fax:
Practice Address - Street 1:1745 CITY CIRCLE RD BLDG B
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7059
Practice Address - Country:US
Practice Address - Phone:912-705-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily