MEDICARE: INTEGRITY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	54794	GA

General Provider Information

NPI Number	:	1396055091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 184
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0184
Country	:	US
Telephone Number	:	706-507-3332
Fax Number	:	706-507-3359

Provider Business Practice Location Address
First Line	:	400 BROOKSTONE CENTRE PKWY
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3639
Country	:	US
Telephone Number	:	706-507-3332
Fax Number	:	706-507-3359

Authorized Official
Title or Position	:	CEO
Name	:	DR. SAMANTHA LYN BOROUGHS
Credential	:	MD
Telephone Number	:	706-987-7509

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	08/08/2022

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