Healthcare Provider Details

I. General information

NPI: 1639092240
Provider Name (Legal Business Name): INTEGRATIVE PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 PEACHTREE RD NE STE 250
ATLANTA GA
30309-1857
US

IV. Provider business mailing address

1819 PEACHTREE RD NE STE 250
ATLANTA GA
30309-1857
US

V. Phone/Fax

Practice location:
  • Phone: 770-852-5551
  • Fax: 770-852-8557
Mailing address:
  • Phone: 770-852-5551
  • Fax: 770-852-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MAIRIN JEROME
Title or Position: FOUNDER
Credential: MD
Phone: 770-852-5551