Provider Demographics
NPI:1245914449
Name:CHASTAIN INTEGRATIVE MEDICINE LLC
Entity type:Organization
Organization Name:CHASTAIN INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONTESSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-308-1701
Mailing Address - Street 1:4959 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4419
Mailing Address - Country:US
Mailing Address - Phone:616-308-1701
Mailing Address - Fax:404-975-3191
Practice Address - Street 1:80 W WIEUCA RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3243
Practice Address - Country:US
Practice Address - Phone:470-443-8988
Practice Address - Fax:404-975-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty