Provider Demographics
NPI:1760776595
Name:BELL, AMBER VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:VIVIAN
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 1:2539 PIEDMONT RD NE
Mailing Address - Street 2:T-2171
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3006
Mailing Address - Country:US
Mailing Address - Phone:404-720-1082
Mailing Address - Fax:404-720-1082
Practice Address - Street 1:2539 PIEDMONT RD NE
Practice Address - Street 2:T-2171
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3006
Practice Address - Country:US
Practice Address - Phone:404-720-1082
Practice Address - Fax:404-720-1082
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist