MEDICARE: BJMM MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1588052641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJMM MEDICAL LLC

Provider Business Mailing Address
First Line	:	1287 GLENWOOD AVE SE STE C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1932
Country	:	US
Telephone Number	:	404-314-3758
Fax Number	:	404-419-6494

Provider Business Practice Location Address
First Line	:	1287 GLENWOOD AVE SE STE C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1932
Country	:	US
Telephone Number	:	404-314-3758
Fax Number	:	404-419-6494

Authorized Official
Title or Position	:	MANAGER
Name	:	SARA BADIE
Credential	:
Telephone Number	:	404-314-3758

Provider Enumeration Date	:	12/24/2014
Last Update Date	:	12/24/2014

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Directions to “BJMM MEDICAL LLC ” Practice Location

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