Individual
SELINA E REVELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
275 N MAIN ST, BAXLEY, GA 31513-0516
(912) 785-7022
(912) 705-8010
Mailing address
275 N MAIN ST, BAXLEY, GA 31513-0516
(912) 785-7022
(912) 705-8010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN073465
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000965478A
—
GA
Enumeration date
09/09/2005
Last updated
05/09/2023
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