Provider Demographics
NPI:1578519948
Name:INTERNAL MEDICINE CENTER, INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NISAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-279-1757
Mailing Address - Street 1:1407 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2631
Mailing Address - Country:US
Mailing Address - Phone:706-279-1757
Mailing Address - Fax:706-279-1758
Practice Address - Street 1:1407 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2631
Practice Address - Country:US
Practice Address - Phone:706-279-1757
Practice Address - Fax:706-279-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAXID