Healthcare Provider Details

I. General information

NPI: 1366564270
Provider Name (Legal Business Name): GIGI DENEAN BELL-WADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 RIDGE OAK RUN SE
MABLETON GA
30126-5925
US

IV. Provider business mailing address

PO BOX 1187
MABLETON GA
30126-1003
US

V. Phone/Fax

Practice location:
  • Phone: 770-819-1635
  • Fax: 770-819-1635
Mailing address:
  • Phone: 770-819-1635
  • Fax: 770-819-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number042524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: