Provider Demographics
NPI:1336572023
Name:BELCHER, JIMMY DALE SR
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DALE
Last Name:BELCHER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 ARMOUR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5233
Mailing Address - Country:US
Mailing Address - Phone:706-221-2982
Mailing Address - Fax:706-221-2986
Practice Address - Street 1:4924 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5233
Practice Address - Country:US
Practice Address - Phone:706-221-2982
Practice Address - Fax:706-221-2986
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS0000242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist