Healthcare Provider Details

I. General information

NPI: 1205834181
Provider Name (Legal Business Name): WILLIE W BELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 OCILLA RD
DOUGLAS GA
31533-2209
US

IV. Provider business mailing address

PO BOX 1377
DOUGLAS GA
31534-1377
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-0600
  • Fax: 912-384-0601
Mailing address:
  • Phone: 912-384-1477
  • Fax: 912-384-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number027030
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: