Healthcare Provider Details

I. General information

NPI: 1588052641
Provider Name (Legal Business Name): BJMM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 12/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 GLENWOOD AVE SE STE C
ATLANTA GA
30316-1932
US

IV. Provider business mailing address

1287 GLENWOOD AVE SE STE C
ATLANTA GA
30316-1932
US

V. Phone/Fax

Practice location:
  • Phone: 404-314-3758
  • Fax: 404-419-6494
Mailing address:
  • Phone: 404-314-3758
  • Fax: 404-419-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: SARA BADIE
Title or Position: MANAGER
Credential:
Phone: 404-314-3758