Healthcare Provider Details

I. General information

NPI: 1982108098
Provider Name (Legal Business Name): BAMP CLINICS GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 DALLAS HWY SW STE 200
MARIETTA GA
30064-6426
US

IV. Provider business mailing address

3405 DALLAS HWY SW STE 200
MARIETTA GA
30064-6426
US

V. Phone/Fax

Practice location:
  • Phone: 844-848-6796
  • Fax: 844-848-6796
Mailing address:
  • Phone: 678-802-8665
  • Fax: 678-540-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER WICKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 678-802-8665