Provider Demographics
NPI:1225482474
Name:INTEGRATED MEDICAL ENTERPRISES,INC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL ENTERPRISES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:MADU STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE,BSN
Authorized Official - Phone:770-940-9941
Mailing Address - Street 1:947 ABBEY PARK WAY
Mailing Address - Street 2:ABBEY PARK WAY
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3377
Mailing Address - Country:US
Mailing Address - Phone:770-940-9941
Mailing Address - Fax:770-417-8263
Practice Address - Street 1:2140 MCGEE RD
Practice Address - Street 2:SUITE C530
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2980
Practice Address - Country:US
Practice Address - Phone:770-940-9941
Practice Address - Fax:770-417-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134161163W00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003159264AMedicaid