MEDICARE: ADVANCED INTEGRATED HEALTH & PHYSICAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	049970	GA

General Provider Information

NPI Number	:	1962802512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INTEGRATED HEALTH & PHYSICAL MEDICINE

Provider Business Mailing Address
First Line	:	325 HAMMOND DR
Second Line	:	SUITE 201-A
City	:	ATLANTA
State	:	GA
Zip	:	30328-5032
Country	:	US
Telephone Number	:	404-256-0114
Fax Number	:	404-256-0167

Provider Business Practice Location Address
First Line	:	325 HAMMOND DR
Second Line	:	SUITE 201-A
City	:	ATLANTA
State	:	GA
Zip	:	30328-5032
Country	:	US
Telephone Number	:	404-256-0114
Fax Number	:	404-256-0167

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	LYNNE CUNNINGHAM
Credential	:	M.D.
Telephone Number	:	404-256-0114

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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Directions to “ADVANCED INTEGRATED HEALTH & PHYSICAL MEDICINE ” Practice Location

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