Provider Demographics
NPI:1205850435
Name:BELENCHIA, JOHNNY M (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:M
Last Name:BELENCHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CAIRO RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 E PINETREE BLVD STE C
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4875
Practice Address - Country:US
Practice Address - Phone:229-584-5731
Practice Address - Fax:229-228-2492
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11332207RP1001X
GA071207207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559353OtherAMERICAN ADMIN GROUP
290013888OtherRAILROAD MEDICARE
GA003142520AMedicaid
MS00124286Medicaid
LA1419672Medicaid
GA003142520BMedicaid
GA003142520BMedicaid
MS00124286Medicaid
4N0037460Medicare PIN
E35077Medicare UPIN