Provider Demographics
NPI:1235632282
Name:INTEGRATED HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-289-4815
Mailing Address - Street 1:4480 S COBB DR SE STE H-302
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6990
Mailing Address - Country:US
Mailing Address - Phone:404-289-4815
Mailing Address - Fax:
Practice Address - Street 1:4150 SNAPFINGER WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3417
Practice Address - Country:US
Practice Address - Phone:404-289-4815
Practice Address - Fax:678-705-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty