Provider Demographics
NPI:1689485799
Name:GAMD PCP MEDICAL GROUP LLC
Entity type:Organization
Organization Name:GAMD PCP MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KWASI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-824-8446
Mailing Address - Street 1:5473 OLD FLOYD RD SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2203
Mailing Address - Country:US
Mailing Address - Phone:480-824-8446
Mailing Address - Fax:
Practice Address - Street 1:5473 OLD FLOYD RD SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2203
Practice Address - Country:US
Practice Address - Phone:480-824-8446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251J00000XAgenciesNursing Care
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No305R00000XManaged Care OrganizationsPreferred Provider Organization