Basic Information
| Provider Information | |||||||||
| NPI: | 1326696071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLERS | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | CARSON | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 HODGSON CT STE 2 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314061523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126292290 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11700 MERCY BLVD STE 5 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314191753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9129276270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2019 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN246136 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.