Provider Demographics
NPI:1629420260
Name:ATLANTA INTEGRATIVE MEDICAL CENTER
Entity Type:Organization
Organization Name:ATLANTA INTEGRATIVE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-515-0688
Mailing Address - Street 1:1891 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2512
Mailing Address - Country:US
Mailing Address - Phone:678-515-0688
Mailing Address - Fax:404-249-8230
Practice Address - Street 1:1891 HOWELL MILL RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2512
Practice Address - Country:US
Practice Address - Phone:678-515-0688
Practice Address - Fax:404-249-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62402261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G703288Medicare PIN