Provider Demographics
NPI:1396055091
Name:INTEGRITY MEDICAL GROUP
Entity type:Organization
Organization Name:INTEGRITY MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BOROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-987-7509
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0184
Mailing Address - Country:US
Mailing Address - Phone:706-507-3332
Mailing Address - Fax:706-507-3359
Practice Address - Street 1:400 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3639
Practice Address - Country:US
Practice Address - Phone:706-507-3332
Practice Address - Fax:706-507-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty