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General NPI Number Information
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NPI Number | 1396055091
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Entity Type | Organization
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Legal Business Name | INTEGRITY MEDICAL GROUP
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 400 BROOKSTONE CENTRE PKWY SUITE 200
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City | COLUMBUS
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State | GA
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Zip | 31904-3639
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Country | US
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Telephone | 706-507-3332
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Fax | 706-507-3359
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | FORTSON
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State | GA
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Zip | 31808-0184
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Country | US
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Telephone | 706-507-3332
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Fax | 706-507-3359
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Authorized Official
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Title or Position | CEO
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Name | DR. SAMANTHA LYN BOROUGHS
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Credential | MD
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Telephone | 706-987-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 54794
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License Number State | GA
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