Innovative Medical, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

058168 Issued in GA

Legal business name

INNOVATIVE MEDICAL, INC.

Doing business as

Novo Total Wellness

Practice address

1300 Peachtree Industrial Blvd
Suite 2203
Suwanee, GA 30024-4539

Phone

(770) 988-2779

Fax

(678) 730-0229

NPI assigned

Jan 13, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Connie Y Jeon, DPT, MPH

Title

Clinic Director

Phone

(770) 988-2779

Specialties & licenses 1

Addresses

Other names 1

• Novo Total Wellness Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1003146143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 2203",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-988-2779",
            "fax_number": "678-730-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 2203",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-988-2779",
            "fax_number": "678-730-0229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-13",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "JEON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "770-988-2779",
        "authorized_official_credential": "DPT, MPH"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "058168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novo Total Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Infectious Disease Consultants, PC
• Infuse One Ga LLC
• Lily Ingle, RBT
• Holly Elizabeth Ingold
• Innovative Health, Inc (Novo Physical Therapy/ Pilates)
• Inovasleep LLC
• Inspire Chiropractic Inc (Inspire Chiropractic)
• Inspire Specialty Care LLC
• Integrated Heathcare Center of Suwanee LLC
• Integrated Modern Health (Imh)

• Family Medicine Physician in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.