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General NPI Number Information
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NPI Number | 1548764988
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL MANAGEMENT GROUP
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 710 DACULA RD STE 4A
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City | DACULA
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State | GA
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Zip | 30019-7014
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Country | US
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Telephone | 678-478-4305
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Fax | 678-608-3411
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Provider Business Mailing Address
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Address Line | 710 DACULA RD STE 4A #125
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City | DACULA
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State | GA
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Zip | 30019-7014
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Country | US
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Telephone | 678-478-4305
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Fax | 678-608-3411
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CASSAUNDRA GRAVES
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Credential |
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Telephone | 678-478-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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