MEDICARE: MR. JIMMY DALE BELCHER SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	HADS0000242	GA

General Provider Information

NPI Number	:	1336572023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMY DALE BELCHER SR.

Provider Business Mailing Address
First Line	:	4924 ARMOUR RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5233
Country	:	US
Telephone Number	:	706-221-2982
Fax Number	:	706-221-2986

Provider Business Practice Location Address
First Line	:	4924 ARMOUR RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5233
Country	:	US
Telephone Number	:	706-221-2982
Fax Number	:	706-221-2986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	05/10/2026

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