Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 88612 | GA |
NPI | 1003311432 |
---|---|
Provider Name | Clayton Paul Michael Bellam |
First Address | Columbus, GA 31909-2453 |
Second Address | Columbus, GA 31909-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 26/06/2021 |