Provider Demographics
NPI:1770562696
Name:BELLAMY, MAXINE S (FNP-C)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:S
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLAYTON STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1250
Mailing Address - Country:US
Mailing Address - Phone:678-846-6049
Mailing Address - Fax:678-466-4944
Practice Address - Street 1:2000 CLAYTON STATE BLVD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1250
Practice Address - Country:US
Practice Address - Phone:678-846-6049
Practice Address - Fax:678-466-4944
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018949363L00000X
GARN085627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJXCMedicare UPIN