# MID ATLANTIC MEDICAL MANAGEMENT , LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568904712
- **Authorized official:** ATLEE T WAMPLER IV DC (CEO/OWNER)
- **Authorized official phone:** (678) 524-6828

## Contact information

- **Practice address:** 3050 CRAIN HWY STE 101A, WALDORF, MD 20601-2823
- **Practice address phone:** (240) 754-7130
- **Mailing address:** PO BOX 566455, ATLANTA, GA 31156-6455
- **Mailing address phone:** (770) 504-5162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | D0068492 | MD | Yes |

## Other

- **Enumeration date:** 11/04/2016
- **Last updated:** 11/04/2016