Provider Demographics
NPI:1588978530
Name:INTEGRATED HEALTH SOLUTIONS OF MARIETTA, LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH SOLUTIONS OF MARIETTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-581-8442
Mailing Address - Street 1:3405 DALLAS HWY SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6426
Mailing Address - Country:US
Mailing Address - Phone:678-581-8442
Mailing Address - Fax:770-635-8641
Practice Address - Street 1:3405 DALLAS HWY SW
Practice Address - Street 2:SUITE 301
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6426
Practice Address - Country:US
Practice Address - Phone:678-581-8442
Practice Address - Fax:770-635-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty