Provider Demographics
NPI:1992566111
Name:BELLAMY-DOUGLAS, DESHAWN D
Entity type:Individual
Prefix:MRS
First Name:DESHAWN
Middle Name:D
Last Name:BELLAMY-DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5562 VILLAGE TRCE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-5147
Mailing Address - Country:US
Mailing Address - Phone:786-277-9720
Mailing Address - Fax:
Practice Address - Street 1:5562 VILLAGE TRCE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-5147
Practice Address - Country:US
Practice Address - Phone:786-277-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No174H00000XOther Service ProvidersHealth Educator