Provider Demographics
NPI:1720778129
Name:SELLERS, SHARON (MED, EDS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SOUTH PERRY STREET
Mailing Address - Street 2:SUITE 206 #2712
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:678-618-1804
Mailing Address - Fax:
Practice Address - Street 1:3915 HARRISON RD STE 300
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5896
Practice Address - Country:US
Practice Address - Phone:678-618-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health