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NPI Code Detail

MEDICARE: BELLAIRE WOUND CARE GEORGIA PC

MEDICARE: BELLAIRE WOUND CARE GEORGIA PC
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1396697991
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLAIRE WOUND CARE GEORGIA PC
Provider Business Mailing Address
First Line : 12600 DEERFIELD PKWY STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6130
Country : US
Telephone Number : 470-422-7029
Fax Number : 855-574-0808
Provider Business Practice Location Address
First Line : 12600 DEERFIELD PKWY STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6130
Country : US
Telephone Number : 470-422-7029
Fax Number : 855-574-0808
Authorized Official
Title or Position : DIRECTOR
Name : OWEN B ELLINGTON
Credential :
Telephone Number : 470-422-7029
Provider Enumeration Date : 02/14/2026
Last Update Date : 02/18/2026

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Directions to “BELLAIRE WOUND CARE GEORGIA PC ” Practice Location

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