1073533972 NPI number — DR. CLARICE MARIJETTA BELL M.D.

Table of content: DR. CLARICE MARIJETTA BELL M.D. (NPI 1073533972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073533972 NPI number — DR. CLARICE MARIJETTA BELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELL
Provider First Name:
CLARICE
Provider Middle Name:
MARIJETTA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL-STRAYHORN
Provider Other First Name:
CLARICE
Provider Other Middle Name:
MARIJETTA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073533972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4990 GUILFORD FOREST DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30331-9017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-457-9051
Provider Business Mailing Address Fax Number:
404-343-1278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 HILLANDALE DR
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-322-9660
Provider Business Practice Location Address Fax Number:
770-322-1981
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  039730 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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