Provider Demographics
NPI:1265253009
Name:BELLAMY, JASMINE DIONNE (LMT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DIONNE
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 DALLY TRL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0772
Mailing Address - Country:US
Mailing Address - Phone:770-687-4811
Mailing Address - Fax:
Practice Address - Street 1:2139 LIDDELL DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4132
Practice Address - Country:US
Practice Address - Phone:770-687-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty