Provider Demographics
NPI:1063521102
Name:SELLERS, GLADSTONE ARNOLD (MD)
Entity type:Individual
Prefix:DR
First Name:GLADSTONE
Middle Name:ARNOLD
Last Name:SELLERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:755 MOUNT VERNON HWY NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4274
Mailing Address - Country:US
Mailing Address - Phone:404-252-4100
Mailing Address - Fax:404-252-6741
Practice Address - Street 1:755 MOUNT VERNON HWY NE
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-252-4100
Practice Address - Fax:404-252-6741
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA035513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035513OtherSTATE LISCENCE
GAAS2811568OtherDEA NUMBER
GAD92816Medicare UPIN
GA11BDFHFMedicare ID - Type Unspecified