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General NPI Number Information
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NPI Number | 1669027132
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 1832 INDEPENDENCE SQ STE D
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City | DUNWOODY
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State | GA
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Zip | 30338-5166
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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 | 1832 INDEPENDENCE SQ STE D
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City | DUNWOODY
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State | GA
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Zip | 30338-5166
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Country | US
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Telephone | 678-478-4305
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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 | MS. CASSAUNDRA GRAVES
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Credential |
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Telephone | 678-608-1904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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