# BETHEL GROUP OF GEORGIA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467572321
- **Authorized official:** MR. JORGE JUAN BACALLAO (DIRECTOR)
- **Authorized official phone:** (404) 735-9844

## Contact information

- **Practice address:** 2870 PEACHTREE RD NW, SUITE 919, ATLANTA, GA 30305-2918
- **Practice address phone:** (404) 735-9844
- **Practice address fax:** (404) 355-4669
- **Mailing address:** 2870 PEACHTREE RD NW, SUITE 919, ATLANTA, GA 30305-2918
- **Mailing address phone:** (404) 735-9844
- **Mailing address fax:** (404) 355-4669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 139625LGB | GA | Yes |

## Other

- **Enumeration date:** 04/01/2007
- **Last updated:** 08/22/2020