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General NPI Number Information
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NPI Number | 1366700544
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Entity Type | Organization
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Legal Business Name | BELLA DERMATOLOGY
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 110 WALTER WAY UNIT 98
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9500
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Country | US
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Telephone | 770-507-8481
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Fax | 770-507-5358
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Provider Business Mailing Address
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Address Line | 110 WALTER WAY UNIT 98
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9500
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Country | US
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Telephone | 770-507-8481
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Fax | 770-507-5358
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY L SHARPE
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Credential | MD
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Telephone | 770-507-8481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 025826
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License Number State | GA
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