INTEGRATIVE MEDICAL GROUP AND MEDICAL SPA, INC (NPI# 1417593047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417593047 |
| Entity Type | Organization |
| Organization Name | INTEGRATIVE MEDICAL GROUP AND MEDICAL SPA, INC |
| Practice Address |
805 Lambert Dr Ne Ste C Atlanta GA 30324-4189 |
| Practice Telephone | 6785613023 |
| Mailing Telephone | 6785613023 |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2019-11-19 |
| Authorized Official Name | AVA COOPER-CADRES (CEO) |
| Authorized Official Telephone | 6784631719 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Integrative Medical Group and Medical Spa, Inc | Other Name - Individual/Organization |
| Street Address |
805 LAMBERT DR NE STE C |
| City | ATLANTA |
| State | GA |
| Zip Code | 30324-4189 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174158919 | Marianella Anzola | Dietitian, Registered | Grady Brookhaven Health Center, 2695 Buford Hwy Ne 200, Atlanta, GA 30324 | 2020-03-11 |
| 1326515636 | Jacqueline Beckhom | Rehabilitation Counselor | Trinity Social Services, LLC 50 Lenox Pointe, Ne Suite, Atlanta, GA 30324 | 2018-10-25 |
| 1366925497 | David Wayne Richardson | Psychiatry & Neurology | 400 Rock Springs Road Ne, Atlanta, GA 30324 | 2018-09-14 |
| 1730625989 | Hwh, LLC | In Home Supportive Care | 1108 Pine Heights Dr Ne, Atlanta, GA 30324 | 2017-01-12 |
| 1780134403 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 2452 Morosgo Way Ne, Atlanta, GA 30324 | 2016-10-05 |
| 1063891372 | Jacqueline Nguyen | Family Medicine | 1125 Norwich Cir Ne, Atlanta, GA 30324 | 2015-05-20 |
| 1306277595 | Gerald Elroy Mitchell | Occupational Therapist | 1261 La Vista Road Ne, L - 4, Atlanta, GA 30324 | 2013-12-12 |
| 1487086138 | Continuum Care Group | Anesthesiology | 3574 Lenox Rd, 655, Atlanta, GA 30324 | 2013-08-05 |
| 1336589183 | Mary Azar Pride | Registered Nurse | 30-b Lenox Pte. N.e., Bldg 30 - Suite B, Atlanta, GA 30324 | 2013-06-26 |
| 1447594569 | Harley Anti-aging Institute LLC | Medical Genetics, Ph.D. Medical Genetics | 2678 Buford Highway Ne, Atlanta, GA 30324 | 2012-11-15 |
| Find all providers in zip 30324 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1588015648 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 1000 Techwood Dr Nw, Atlanta, GA 30318 | 2016-06-29 |
| 1598000234 | Medical Wellness Group | Clinic/Center | 2015 Mlk Jr Drive, Atlanta, GA 30310 | 2012-12-06 |
| 1861788986 | Dynamic 1 Medical and Rehab Clinic | Clinic/Center | 2015 Martin Luther King Jr Drive Suite B, Atlanta, GA 30310 | 2011-06-27 |
| 1124333547 | Benchmark Healthcare Services LLC | Clinic/Center | 550 Peachtree St Ne Ste 1775, Atlanta, GA 30308-2264 | 2010-08-10 |
| 1851604375 | Independent Physical Therapy of Ga, LLC | Clinic/Center | 3200 Downwood Cir Nw Ste 380, Atlanta, GA 30327-1610 | 2010-07-26 |
| 1366595118 | Thacker & Thompson | Clinic/Center | 619 Rankin St Ne, Atlanta, GA 30308-2920 | 2007-01-18 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.