MEDICARE: INTEGRATED HEALTHCARE CENTER OF HIRAM LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1699225094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTHCARE CENTER OF HIRAM LLC

Provider Business Mailing Address
First Line	:	3441 LAWRENCEVILLE SUWANEE RD
Second Line	:	SUITE C
City	:	SUWANEE
State	:	GA
Zip	:	30024-6503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 HIGHLAND PAVILION CT
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-4119
Country	:	US
Telephone Number	:	770-439-6997
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MONICA SHELTON
Credential	:
Telephone Number	:	678-730-6240

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	10/10/2016

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