Provider Demographics
NPI:1649775412
Name:DAVIS, BELLAMY CLARISSA (PAC)
Entity Type:Individual
Prefix:
First Name:BELLAMY
Middle Name:CLARISSA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BELLAMY
Other - Middle Name:CLARISSA
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3485 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5603
Mailing Address - Country:US
Mailing Address - Phone:205-930-0920
Mailing Address - Fax:205-445-0151
Practice Address - Street 1:3485 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5603
Practice Address - Country:US
Practice Address - Phone:205-930-0920
Practice Address - Fax:205-445-0151
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1325363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical