Individual
MALLORY K BELLISSIMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3617 ROSWELL RD NE, ATLANTA, GA 30305-1111
(404) 996-0196
(404) 467-2489
Mailing address
961 ADAIR AVE NE, ATLANTA, GA 30306-3809
(717) 497-6851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10513
GA
363A00000X
Physician Assistant
PA60385985
WA
Other
Enumeration date
09/28/2010
Last updated
11/07/2023
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