Provider Demographics
NPI:1073249132
Name:INTEGRATED PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:INTEGRATED PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-793-1597
Mailing Address - Street 1:3333 OLD MILTON PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-0008
Mailing Address - Country:US
Mailing Address - Phone:678-335-6020
Mailing Address - Fax:
Practice Address - Street 1:3333 OLD MILTON PKWY STE 160
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-0008
Practice Address - Country:US
Practice Address - Phone:678-335-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty