Provider Demographics
NPI:1619245669
Name:BELL, KATHERINE E
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:E
Last Name:BELL
Suffix:
Gender:F
Credentials:
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 75
Mailing Address - Street 2:
Mailing Address - City:TATE
Mailing Address - State:GA
Mailing Address - Zip Code:30177-0075
Mailing Address - Country:US
Mailing Address - Phone:678-454-2300
Mailing Address - Fax:678-454-2301
Practice Address - Street 1:4875A HWY 53 EAST
Practice Address - Street 2:
Practice Address - City:TATE
Practice Address - State:GA
Practice Address - Zip Code:30177-3017
Practice Address - Country:US
Practice Address - Phone:678-454-2300
Practice Address - Fax:678-454-2301
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030513163WD0400X
WAPH 60237471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH 60237471OtherPHARMACY LICENSE