Provider Demographics
NPI:1740293471
Name:BELAY, JEANNIE A (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:A
Last Name:BELAY
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:215-476-3981
Practice Address - Street 1:5440 HILLANDALE DRIVE
Practice Address - Street 2:KAISER PERMANENTE PANOLA MEDICAL CENTER
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:770-322-2712
Practice Address - Fax:215-476-3981
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-02-03
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Provider Licenses
StateLicense IDTaxonomies
PAMD 426139208000000X
GA062101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013799620001Medicaid
PAI00398Medicare UPIN