Healthcare Provider Details

I. General information

NPI: 1255364295
Provider Name (Legal Business Name): INTEGRATED THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 WINDWARD PKWY SUITE 200
ALPHARETTA GA
30005-5203
US

IV. Provider business mailing address

5895 WINDWARD PKWY SUITE 200
ALPHARETTA GA
30005-5203
US

V. Phone/Fax

Practice location:
  • Phone: 678-527-2220
  • Fax: 678-527-2222
Mailing address:
  • Phone: 678-527-2220
  • Fax: 678-527-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS K MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866