Provider Demographics
NPI:1598331829
Name:INTEGRATED HEALTHCARE CENTER OF MARIETTA
Entity type:Organization
Organization Name:INTEGRATED HEALTHCARE CENTER OF MARIETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-730-6240
Mailing Address - Street 1:3441 LAWRENCEVILLE SUWANEE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6503
Mailing Address - Country:US
Mailing Address - Phone:787-306-2406
Mailing Address - Fax:678-730-1005
Practice Address - Street 1:3208 CANTON RD STE 112
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3875
Practice Address - Country:US
Practice Address - Phone:770-265-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty