Provider Demographics
NPI:1730915836
Name:AMAZING SHIELD BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:AMAZING SHIELD BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:BOLANLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAJIDE-GBENGA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:470-616-7503
Mailing Address - Street 1:2330 SCENIC HWY S STE 410
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:470-616-7503
Mailing Address - Fax:
Practice Address - Street 1:2330 SCENIC HWY S STE 410
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:470-616-7503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty