Healthcare Provider Details

I. General information

NPI: 1568873792
Provider Name (Legal Business Name): BJ MED MGMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOULEVARD NE STE 318
ATLANTA GA
30312-1283
US

IV. Provider business mailing address

340 BOULEVARD NE STE 318
ATLANTA GA
30312-1283
US

V. Phone/Fax

Practice location:
  • Phone: 404-254-7956
  • Fax:
Mailing address:
  • Phone: 404-254-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: SARA J BADIE
Title or Position: ABMINISTRATOR
Credential:
Phone: 404-257-7956