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General NPI Number Information
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NPI Number | 1518778695
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Entity Type | Organization
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Legal Business Name | INTEGRITY IOM. LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2124 CHESHIRE BRIDGE RD NE APT 1303
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City | ATLANTA
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State | GA
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Zip | 30324-5719
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Country | US
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Telephone | 765-586-2801
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 CHESHIRE BRIDGE RD NE APT 1303
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City | ATLANTA
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State | GA
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Zip | 30324-5719
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Country | US
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Telephone | 765-586-2801
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYLEN LEE PETERSON
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Credential |
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Telephone | 765-586-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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