| Organization Name: | BETHEL GROUP OF GEORGIA INC |
| NPI Number: | 1467572321 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JORGE JUAN BACALLAO (DIRECTOR) |
| Mailing Address: | 2870 Peachtree Rd Nw Suite 919 Atlanta |
| State: | GA US |
| Postal Code: | 303052918 |
| Phone Number: | 4047359844 |
| Fax Number: | 4043554669 |
| NPI Enumeration Date: | 04/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 139625LGB |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |