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General NPI Number Information
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NPI Number | 1629381876
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Entity Type | Individual
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Provider Name | RAVEN KAE BELMONTE ATC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 4484 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30319
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Country | US
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Telephone | 404-261-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 111 RYAN WAY SE
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City | SMYRNA
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State | GA
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Zip | 30080-8258
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Country | US
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Telephone | 919-868-0943
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Fax |
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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 | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 2000003701
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License Number State | GA
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