Basic Information
| Provider Information | |||||||||
| NPI: | 1639290687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 NORTHSIDE BLVD | ||||||||
| Address2: | SUITE 3500 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD | ||||||||
| Address2: | SUITE 3500 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 09/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN050794 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000423387C | 05 | GA | MEDICAID |