Provider Demographics
NPI:1619374378
Name:JIMMY D BELLAMY DMD LLC
Entity Type:Organization
Organization Name:JIMMY D BELLAMY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-267-5784
Mailing Address - Street 1:426 WADLEY COLEMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MIDVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30441-4934
Mailing Address - Country:US
Mailing Address - Phone:678-267-5784
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL OFFICE WAY
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401
Practice Address - Country:US
Practice Address - Phone:478-419-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA387552845BMedicaid