Healthcare Provider Details

I. General information

NPI: 1225650047
Provider Name (Legal Business Name): DELORES E BEDELL BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DELORES E SAMUKAI

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 12/10/2025
Certification Date: 05/14/2020
Deactivation Date: 05/14/2020
Reactivation Date: 12/10/2025

III. Provider practice location address

10 PERIMETER PARK DR APT 217
ATLANTA GA
30341-1341
US

IV. Provider business mailing address

10 PERIMETER PARK DR APT 217
ATLANTA GA
30341-1341
US

V. Phone/Fax

Practice location:
  • Phone: 404-502-3813
  • Fax:
Mailing address:
  • Phone: 404-502-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN265186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: