Provider Demographics
NPI:1720639461
Name:ICEBERG HEALTH LLC
Entity Type:Organization
Organization Name:ICEBERG HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:770-971-8115
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD STE 400B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4100
Mailing Address - Country:US
Mailing Address - Phone:678-985-0444
Mailing Address - Fax:678-878-2330
Practice Address - Street 1:1670 MCKENDREE CHURCH RD STE 400B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4100
Practice Address - Country:US
Practice Address - Phone:678-985-0444
Practice Address - Fax:678-878-2330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUST HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty