Provider Demographics
NPI:1801256326
Name:THE CENTER FOR INTERNAL & INTEGRATIVE MEDICINE, PA
Entity type:Organization
Organization Name:THE CENTER FOR INTERNAL & INTEGRATIVE MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FATAKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-256-7069
Mailing Address - Street 1:401 S MAIN ST STE B3
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1958
Mailing Address - Country:US
Mailing Address - Phone:404-836-9906
Mailing Address - Fax:470-545-4768
Practice Address - Street 1:401 S MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1958
Practice Address - Country:US
Practice Address - Phone:404-836-9906
Practice Address - Fax:470-545-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71068207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1295099018OtherNPI INDIVIDUAL
GA1710241658OtherINDIVIDUAL NPI NUMBER