Provider Demographics
NPI:1457314742
Name:BELLECCI, PAULINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:MARIE
Last Name:BELLECCI
Suffix:
Gender:F
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3424 HWY 252 EAST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537
Practice Address - Country:US
Practice Address - Phone:912-496-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA032345OtherGA LICENSE
FLME95858OtherFLORIDA STATE LICENSE
ARN6950OtherARKANSAS STATE LICENSE
GA110045694OtherPALMETTO GBA MEDICARE
GA11BDDMJMedicare UPIN
FLAB745ZMedicare PIN
ARN6950OtherARKANSAS STATE LICENSE