Provider Demographics
NPI:1407362023
Name:INTEGRATIVE MEDICAL CLINIC OF NORTH CAROLINA, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL CLINIC OF NORTH CAROLINA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIEANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:984-999-0902
Mailing Address - Street 1:815 OLD PITTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-3019
Mailing Address - Country:US
Mailing Address - Phone:984-999-0902
Mailing Address - Fax:
Practice Address - Street 1:5915 FARRINGTON RD STE 106
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:984-999-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty