Provider Demographics
NPI:1245406073
Name:JIMMY D. BELLAMY DMD.,PC
Entity Type:Organization
Organization Name:JIMMY D. BELLAMY DMD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-996-2001
Mailing Address - Street 1:328 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8680
Mailing Address - Country:US
Mailing Address - Phone:706-279-1802
Mailing Address - Fax:
Practice Address - Street 1:328 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8680
Practice Address - Country:US
Practice Address - Phone:706-279-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA387552845AMedicaid