Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8567 | GA |
Y | 213EG0000X | General Practice | 8567 | GA |
NPI | 1003854118 |
---|---|
Provider Name | Dr. Jimmy D. Bellamy |
First Address | Dalton, GA 30722-1802 |
Second Address | Swainsboro, GA 30401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 01/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387552845A | (05) | GA |