Provider Demographics
NPI:1760262869
Name:ADVANCED INTEGRATED MEDICINE OF GA, LLC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATED MEDICINE OF GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-734-5460
Mailing Address - Street 1:PO BOX 957175
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9520
Mailing Address - Country:US
Mailing Address - Phone:770-734-5460
Mailing Address - Fax:
Practice Address - Street 1:3296 SUMMIT RIDGE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6301
Practice Address - Country:US
Practice Address - Phone:770-734-5460
Practice Address - Fax:770-734-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty