Provider Demographics
NPI:1902865256
Name:WELLMAN, BELVA-ANNE JERNIGAN (PT)
Entity Type:Individual
Prefix:
First Name:BELVA-ANNE
Middle Name:JERNIGAN
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 PALLADIAN VILLAGE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8200
Mailing Address - Country:US
Mailing Address - Phone:678-670-1289
Mailing Address - Fax:678-348-7137
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8200
Practice Address - Country:US
Practice Address - Phone:678-670-1289
Practice Address - Fax:678-348-7137
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922611BMedicaid