Provider Demographics
NPI:1588168660
Name:INTEGRATIVE MEDICAL MANAGEMENT GROUP-ATLANTA
Entity type:Organization
Organization Name:INTEGRATIVE MEDICAL MANAGEMENT GROUP-ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-478-4305
Mailing Address - Street 1:710 DACULA RD SUITE 4A #125
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019
Mailing Address - Country:US
Mailing Address - Phone:678-608-1984
Mailing Address - Fax:
Practice Address - Street 1:4080 MCGINNIS FERRY RD STE 402
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3949
Practice Address - Country:US
Practice Address - Phone:678-478-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty