Provider Demographics
NPI:1881145290
Name:ABC MIDWIFERY CLINIC LLC
Entity type:Organization
Organization Name:ABC MIDWIFERY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-474-2770
Mailing Address - Street 1:1 BALTIMORE PL NW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2116
Mailing Address - Country:US
Mailing Address - Phone:404-474-2770
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE PL NW
Practice Address - Street 2:SUITE 105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:404-474-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA BIRTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty