Basic Information
| Provider Information | |||||||||
| NPI: | 1306476759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLERS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3613 COUGHLIN CT | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043143891 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285011604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525227000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0010-9729 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363A00000X | 0010-9729 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.