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General NPI Number Information
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NPI Number | 1306172416
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Entity Type | Organization
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Legal Business Name | IVERSON BELL JR MD PC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 3915 CASCADE RD SW SUITE T-148
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 770-394-9562
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Fax | 770-828-0567
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Provider Business Mailing Address
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Address Line | 3915 CASCADE RD SW SUITE T-148
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 770-394-9562
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Fax | 770-828-0567
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVERSON CHARLES BELL JR.
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Credential | MD
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Telephone | 770-394-9562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 021376
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License Number State | GA
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