Healthcare Provider Details

I. General information

NPI: 1346005824
Provider Name (Legal Business Name): IPM INSTITUTE AT SALUDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NORTHOLT PKWY
SUWANEE GA
30024-4360
US

IV. Provider business mailing address

601 NORTHOLT PKWY
SUWANEE GA
30024-4360
US

V. Phone/Fax

Practice location:
  • Phone: 770-904-3222
  • Fax: 470-795-7719
Mailing address:
  • Phone: 770-904-3222
  • Fax: 470-795-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN WANG
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 770-904-3222