Provider Demographics
NPI:1952520041
Name:INTEGRATED HEALTHCARE OF WOODSTOCK
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE OF WOODSTOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-517-1456
Mailing Address - Street 1:3353 TRICKUM RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3686
Mailing Address - Country:US
Mailing Address - Phone:770-517-1456
Mailing Address - Fax:678-238-0352
Practice Address - Street 1:3353 TRICKUM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3686
Practice Address - Country:US
Practice Address - Phone:770-517-1456
Practice Address - Fax:678-238-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6463111N00000X
GA008738208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1033184056OtherDR. WILLIAMS NPI
GA1831164128OtherDR. COCHRAN NPI
GA35ZCHGJMedicare ID - Type UnspecifiedDR. DAVID WILLIAMS
GA1831164128OtherDR. COCHRAN NPI
GA1033184056OtherDR. WILLIAMS NPI