Provider Demographics
NPI:1063031706
Name:BELMOH, JOSEPHINE FATMATA (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:FATMATA
Last Name:BELMOH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:FATMATA
Other - Last Name:BELMOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JOSEPHINE WEAH
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-932-7773
Mailing Address - Fax:
Practice Address - Street 1:505 DACULA RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2125
Practice Address - Country:US
Practice Address - Phone:615-425-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty