Provider Demographics
NPI:1942445481
Name:A&M MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:A&M MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AINSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-691-1760
Mailing Address - Street 1:3205 INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4963
Mailing Address - Country:US
Mailing Address - Phone:678-691-1760
Mailing Address - Fax:
Practice Address - Street 1:3205 INDUSTRIAL WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4963
Practice Address - Country:US
Practice Address - Phone:770-369-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2009OCC-004391332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6321280001Medicare NSC