Healthcare Provider Details

I. General information

NPI: 1265645907
Provider Name (Legal Business Name): JOSEANGEL DAMIAN BEDOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 COBB PKWY NW STE 800
ACWORTH GA
30101-8346
US

IV. Provider business mailing address

301 BROWNHILL CT
WOODSTOCK GA
30188-2659
US

V. Phone/Fax

Practice location:
  • Phone: 678-919-7200
  • Fax: 678-919-7210
Mailing address:
  • Phone: 707-714-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number63630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: