Provider Demographics
NPI:1124138011
Name:BEDELL, KRISTY L (CNM)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:BEDELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYN
Other - Last Name:MAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:
Practice Address - Street 1:3550 PRESTON RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-663-3163
Practice Address - Fax:770-663-3198
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARH135180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
42BBBQNMedicare ID - Type Unspecified
Q27794Medicare UPIN