Healthcare Provider Details

I. General information

NPI: 1518071182
Provider Name (Legal Business Name): JAMES JOHN BENDELL M.D, PH. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LEWIS ST
LAGRANGE GA
30240-3144
US

IV. Provider business mailing address

310 S LEWIS ST
LAGRANGE GA
30240-3144
US

V. Phone/Fax

Practice location:
  • Phone: 706-845-0500
  • Fax: 706-812-9315
Mailing address:
  • Phone: 706-845-0500
  • Fax: 706-812-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number00022099
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number043546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: