Provider Demographics
NPI:1760700199
Name:GEORGIA INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:GEORGIA INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOON HANG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-814-1333
Mailing Address - Street 1:120 MILBROOK VILLAGE DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290
Mailing Address - Country:US
Mailing Address - Phone:678-814-1333
Mailing Address - Fax:770-774-4431
Practice Address - Street 1:120 MILBROOK VILLAGE DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290
Practice Address - Country:US
Practice Address - Phone:678-814-1333
Practice Address - Fax:770-774-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0583552083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty