Iceberg Holdings LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ICEBERG HOLDINGS LLC

Practice address

1670 McKendree Church Rd Ste 400B
Lawrenceville, GA 30043-4100

Phone

(678) 985-0444

Fax

(470) 823-9759

NPI assigned

May 11, 2020

Organization subpart

No

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

Authorized official

Name

Kamlesh Patel, DC

Title

Chiropractor

Phone

(678) 985-0444

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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

• Brittany Guifarro, DC

  • Chiropractor
  • Atlanta, GA
  • NPI 1427672120
  NPD (past)

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1225650435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 MCKENDREE CHURCH RD STE 400B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300434100",
            "telephone_number": "678-985-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 MCKENDREE CHURCH RD STE 400B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300434100",
            "telephone_number": "678-985-0444",
            "fax_number": "470-823-9759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "552 Ponce De Leon Ave NE Ste 552",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303081806",
            "country_code": "US",
            "telephone_number": "770-609-7246",
            "fax_number": "470-558-2961",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "62 Shawnee Trl SE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300677316",
            "country_code": "US",
            "telephone_number": "770-971-8115",
            "fax_number": "470-823-9752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "697 Ruskin Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Forest Park",
            "state": "GA",
            "postal_code": "302971077",
            "country_code": "US",
            "telephone_number": "770-609-7246",
            "fax_number": "470-558-2961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICEBERG HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "KAMLESH",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "678-985-0444",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lawrenceville@iceberghealth.com",
            "affiliation": "N",
            "endpointDescription": "Email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1670 McKendree Church Rd Ste 400B",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300434100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hypertension & Kidney,PC
• Scholar Ibezim
• Chika Ibiam
• Chinwe Ibiam, NP
• Iceberg Health LLC
• Mark R. Icenogle, AT-C
• Idm Care, LLC
• Farid Ahmad Idris
• Umeadi E Ifeadike Jr., PHARM D
• Henrietta Igali, RN ,BSN

• All providers in Lawrenceville, GA
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.