Provider Demographics
NPI:1831750975
Name:YALLAH, SELMA ALI (PMHNP)
Entity type:Individual
Prefix:
First Name:SELMA
Middle Name:ALI
Last Name:YALLAH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 WELLBROOK CIR NE STE C
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3973
Mailing Address - Country:US
Mailing Address - Phone:770-679-5453
Mailing Address - Fax:770-679-5457
Practice Address - Street 1:1277 WELLBROOK CIR NE STE C
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3973
Practice Address - Country:US
Practice Address - Phone:770-679-5453
Practice Address - Fax:770-679-5457
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health