Provider Demographics
NPI:1689640922
Name:BELL, GARY BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:BERNARD
Last Name:BELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7305
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:11 ATRIUM RIDGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6438
Practice Address - Country:US
Practice Address - Phone:803-699-9992
Practice Address - Fax:803-865-7429
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00761897OtherMEDICARE RAILROAD PTAN
SC119801Medicaid
SCC611245730Medicare PIN
SCP00761897OtherMEDICARE RAILROAD PTAN