Provider Demographics
NPI:1124467063
Name:ADVANTAGE BODYCARE SOLUTIONS, LLC
Entity type:Organization
Organization Name:ADVANTAGE BODYCARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:770-355-8352
Mailing Address - Street 1:500 SUN VALLEY DR
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1482
Mailing Address - Country:US
Mailing Address - Phone:770-355-8352
Mailing Address - Fax:770-977-8081
Practice Address - Street 1:500 SUN VALLEY DR
Practice Address - Street 2:SUITE A-3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1482
Practice Address - Country:US
Practice Address - Phone:770-355-8352
Practice Address - Fax:770-977-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center