Healthcare Provider Details

I. General information

NPI: 1790695310
Provider Name (Legal Business Name): RODRICK BELLAMY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 FORRESTAL DR
DURHAM NC
27703-4785
US

IV. Provider business mailing address

2919 FORRESTAL DR
DURHAM NC
27703-4785
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: