1013393396 NPI number — INTEGRATIVE CAP HEALTH PRACTICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013393396 NPI number — INTEGRATIVE CAP HEALTH PRACTICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE CAP HEALTH PRACTICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013393396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 CARRIAGE STATION CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30075-4655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-259-2206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 HOLCOMB BRIDGE RD
Provider Second Line Business Practice Location Address:
230
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-259-2206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
LEONIE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
DR.
Authorized Official Telephone Number:
404-259-2206

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com