Provider Demographics
NPI:1548764988
Name:INTEGRATIVE MEDICAL MANAGEMENT GROUP
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-478-4305
Mailing Address - Street 1:710 DACULA RD STE 4A #125
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7014
Mailing Address - Country:US
Mailing Address - Phone:678-478-4305
Mailing Address - Fax:678-608-3411
Practice Address - Street 1:710 DACULA RD STE 4A
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7014
Practice Address - Country:US
Practice Address - Phone:678-478-4305
Practice Address - Fax:678-608-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty