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General NPI Number Information
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NPI Number | 1598975708
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Entity Type | Individual
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Provider Name | SETH J BILELLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 130 N BROAD ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-8132
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Country | US
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Telephone | 229-228-6496
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Fax | 229-228-6510
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Provider Business Mailing Address
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Address Line | PO BOX 2717
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City | THOMASVILLE
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State | GA
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Zip | 31799-2717
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Country | US
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Telephone | 229-228-6496
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Fax | 229-228-6510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 64508
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License Number State | GA
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