Provider Demographics
NPI:1366700544
Name:BELLA DERMATOLOGY
Entity type:Organization
Organization Name:BELLA DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-507-8481
Mailing Address - Street 1:110 WALTER WAY UNIT 98
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9500
Mailing Address - Country:US
Mailing Address - Phone:770-507-8481
Mailing Address - Fax:770-507-5358
Practice Address - Street 1:110 WALTER WAY UNIT 98
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9500
Practice Address - Country:US
Practice Address - Phone:770-507-8481
Practice Address - Fax:770-507-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025826207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty