Healthcare Provider Details

I. General information

NPI: 1316320120
Provider Name (Legal Business Name): INTEGRATED HEALTH AND INJURY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 SNAPFINGER WOODS DR STE 200
DECATUR GA
30035-3417
US

IV. Provider business mailing address

4150 SNAPFINGER WOODS DR STE 200
DECATUR GA
30035-3417
US

V. Phone/Fax

Practice location:
  • Phone: 404-288-9000
  • Fax: 678-705-8429
Mailing address:
  • Phone: 404-288-9000
  • Fax: 678-705-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number040613
License Number StateGA

VIII. Authorized Official

Name: ORIE JENKINS
Title or Position: PRESIDENT
Credential:
Phone: 404-229-6222