Individual
MRS. MYRA SELLERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
105 CHERRYWOOD DR, NICHOLLS, GA 31554-3505
(912) 632-6685
Mailing address
105 CHERRYWOOD DR, NICHOLLS, GA 31554-3505
(912) 632-6685
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001931
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
342670
—
GA
Enumeration date
12/19/2006
Last updated
07/08/2007
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