Provider Demographics
NPI:1427350719
Name:SELLERS, LUCINDA JOHNSON (CPNP)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:JOHNSON
Last Name:SELLERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MEMORIAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3236
Mailing Address - Country:US
Mailing Address - Phone:404-296-3800
Mailing Address - Fax:404-297-8753
Practice Address - Street 1:5405 MEMORIAL DR STE D
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3236
Practice Address - Country:US
Practice Address - Phone:404-296-3800
Practice Address - Fax:404-297-8753
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204724363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107139AMedicaid