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General NPI Number Information
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NPI Number | 1639092240
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PHYSICAL MEDICINE
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1819 PEACHTREE RD NE STE 250
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City | ATLANTA
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State | GA
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Zip | 30309-1857
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Country | US
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Telephone | 770-852-5551
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Fax | 770-852-8557
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Provider Business Mailing Address
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Address Line | 1819 PEACHTREE RD NE STE 250
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City | ATLANTA
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State | GA
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Zip | 30309-1857
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Country | US
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Telephone | 770-852-5551
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Fax | 770-852-8557
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Authorized Official
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Title or Position | FOUNDER
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Name | MAIRIN JEROME
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Credential | MD
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Telephone | 770-852-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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