Provider Demographics
NPI:1588039044
Name:IMPEDIO HEALTHCARE, INC
Entity Type:Organization
Organization Name:IMPEDIO HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANI
Authorized Official - Suffix:
Authorized Official - Credentials:ND, PHD
Authorized Official - Phone:770-454-1363
Mailing Address - Street 1:PO BOX 56147
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30343-0147
Mailing Address - Country:US
Mailing Address - Phone:770-454-1363
Mailing Address - Fax:
Practice Address - Street 1:3805 PRESIDENTIAL PKWY
Practice Address - Street 2:STE 106
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3720
Practice Address - Country:US
Practice Address - Phone:770-454-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service