Provider Demographics
NPI:1982108098
Name:BAMP CLINICS GEORGIA, LLC
Entity type:Organization
Organization Name:BAMP CLINICS GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-802-8665
Mailing Address - Street 1:3405 DALLAS HWY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6426
Mailing Address - Country:US
Mailing Address - Phone:678-802-8665
Mailing Address - Fax:678-540-4250
Practice Address - Street 1:3405 DALLAS HWY SW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6426
Practice Address - Country:US
Practice Address - Phone:844-848-6796
Practice Address - Fax:844-848-6796
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS SYNERGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty