Provider Demographics
NPI:1255668794
Name:BELLAM ENTERPRISES INC.
Entity type:Organization
Organization Name:BELLAM ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:WHELCHEL
Authorized Official - Last Name:BELLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-949-6139
Mailing Address - Street 1:1394 E STONEYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2803
Mailing Address - Country:US
Mailing Address - Phone:770-949-6139
Mailing Address - Fax:
Practice Address - Street 1:1394 E STONEYBROOK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2803
Practice Address - Country:US
Practice Address - Phone:770-949-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-R-0573305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service