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General NPI Number Information
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NPI Number | 1306469978
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 975 9TH AVE SW STE 200
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City | BESSEMER
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State | AL
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Zip | 35022-7839
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Country | US
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Telephone | 205-519-4201
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Fax |
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Provider Business Mailing Address
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Address Line | 975 9TH AVE SW STE 200
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City | BESSEMER
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State | AL
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Zip | 35022-7839
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOWELL BRAGG
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Credential | DC
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Telephone | 205-519-4201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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