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General NPI Number Information
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NPI Number | 1588168660
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL MANAGEMENT GROUP-ATLANTA
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 4080 MCGINNIS FERRY RD STE 402
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City | ALPHARETTA
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State | GA
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Zip | 30005-3949
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Country | US
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Telephone | 678-478-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 710 DACULA RD SUITE 4A #125
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 678-608-1984
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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