Healthcare Provider Details

I. General information

NPI: 1245914449
Provider Name (Legal Business Name): CHASTAIN INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W WIEUCA RD NE STE 201
ATLANTA GA
30342-3243
US

IV. Provider business mailing address

4959 NORTHSIDE DR
ATLANTA GA
30327-4419
US

V. Phone/Fax

Practice location:
  • Phone: 470-443-8988
  • Fax: 404-975-3191
Mailing address:
  • Phone: 616-308-1701
  • Fax: 404-975-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CONTESSA D METCALFE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 616-308-1701