Provider Demographics
NPI:1861032252
Name:BELL PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:BELL PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HERMEYONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:404-337-7486
Mailing Address - Street 1:3907 MCKEE MILL TRCE
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2058
Mailing Address - Country:US
Mailing Address - Phone:678-362-1153
Mailing Address - Fax:
Practice Address - Street 1:285 BOULEVARD NE STE 145
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4204
Practice Address - Country:US
Practice Address - Phone:404-337-7486
Practice Address - Fax:352-329-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00084826Medicaid