Provider Demographics
NPI:1437727088
Name:ADVAITA INTEGRATED MEDICINE PLLC
Entity Type:Organization
Organization Name:ADVAITA INTEGRATED MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:EULAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:828-228-6148
Mailing Address - Street 1:6112 SAINT GILES ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7043
Mailing Address - Country:US
Mailing Address - Phone:919-893-4465
Mailing Address - Fax:
Practice Address - Street 1:6112 SAINT GILES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7043
Practice Address - Country:US
Practice Address - Phone:919-893-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty