Provider Demographics
NPI:1215621701
Name:BETHESDA COMMUNITY CLINIC INC
Entity type:Organization
Organization Name:BETHESDA COMMUNITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-880-9654
Mailing Address - Street 1:450 WILBANKS DR STE A
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-6006
Mailing Address - Country:US
Mailing Address - Phone:678-880-9654
Mailing Address - Fax:678-880-9751
Practice Address - Street 1:450 WILBANKS DR STE A
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-6006
Practice Address - Country:US
Practice Address - Phone:678-880-9654
Practice Address - Fax:678-880-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty