Provider Demographics
NPI:1588052641
Name:BJMM MEDICAL LLC
Entity type:Organization
Organization Name:BJMM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-314-3758
Mailing Address - Street 1:1287 GLENWOOD AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1932
Mailing Address - Country:US
Mailing Address - Phone:404-314-3758
Mailing Address - Fax:404-419-6494
Practice Address - Street 1:1287 GLENWOOD AVE SE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1932
Practice Address - Country:US
Practice Address - Phone:404-314-3758
Practice Address - Fax:404-419-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization