Healthcare Provider Details

I. General information

NPI: 1972150332
Provider Name (Legal Business Name): ERNEST LEON BELLEFANT JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 3000
ATLANTA GA
30309-1721
US

IV. Provider business mailing address

5800 RIVER RD APT 116
NASHVILLE TN
37209-5659
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP004313
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26453
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: