Provider Demographics
NPI:1912020116
Name:TOWNSEND, MARY BELLE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BELLE
Last Name:TOWNSEND
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 1:9972 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-8582
Mailing Address - Country:US
Mailing Address - Phone:912-354-4604
Mailing Address - Fax:912-354-1439
Practice Address - Street 1:9972 BOND AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-8582
Practice Address - Country:US
Practice Address - Phone:912-354-4604
Practice Address - Fax:912-354-1439
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00879469AMedicaid