Innovative Therapy Group

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INNOVATIVE THERAPY GROUP

Practice address

690 Thornton Way Ste a
Lithia Springs, GA 30122-2614

Phone

(678) 324-0654

Fax

(678) 810-0841

NPI assigned

Oct 24, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Juan Zermeno DesantosNPI 1881160307

Title

Program Director

Phone

(404) 290-6786

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natalie Bernett Bonner, FNP

  • Family Nurse Practitioner
  • Fayetteville, GA
  • NPI 1972018117
  Medicare reassignment Care Compare group NPD
• Antwan Gilbert Aiken, LCSW, MPA

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1255864161
  Medicare reassignment Care Compare group
• Juan Antonio Zermeno de Santos

  • Mental Health Counselor
  • Union City, GA
  • NPI 1881160307
  NPD Authorized official
• Ranga Rao, M.D.

  • Psychiatry Physician
  • Lawrenceville, GA
  • NPI 1760493837
  Medicare reassignment

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

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1154193142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 THORNTON WAY STE A",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301222614",
            "telephone_number": "678-324-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 THORNTON WAY STE A",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301222614",
            "telephone_number": "678-324-0654",
            "fax_number": "678-810-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE THERAPY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "ZERMENO DESANTOS",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "404-290-6786",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ken Ibeto
• Matthew Igbinigie, MD
• Independent Physical Therapy of Ga LLC
• Independent Physical Therapy of Ga, LLC
• Indigo Healing Minds LLC
• Inspire Speech Therapy LLC
• Internal Medicine Associates of West Atlanta, P.C.
• Itsnme2, LLC.
• J. Keith Smith, D.M.D., P.C.
• Angela Jackson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lithia Springs, GA
• Providers in Lithia Springs, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.