Healthcare Provider Details

I. General information

NPI: 1447322102
Provider Name (Legal Business Name): LARRY JAMES BELL JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 JOHN WESLEY AVE
COLLEGE PARK GA
30337
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE SE ROOM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-4155
  • Fax: 404-765-4149
Mailing address:
  • Phone: 404-730-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR130853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: