Integrated Health Center Corp

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

INTEGRATED HEALTH CENTER CORP

Practice address

8600 Tara Blvd
Suite D
Jonesboro, GA 30236

Phone

(678) 834-7615

NPI assigned

Jan 13, 2016

Organization subpart

No

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

Authorized official

Name

Rodrick Frazier

Title

Ceo

Phone

(678) 765-2733

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 2

Tax ID family

Integrated Health Center Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Integrated Health Center of Ga, LLC

  • Clinical Medical Laboratory
  • Buford, GA
  • NPI 1972053866
  NPD tax ID

Locations

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1336505809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 SCALES RD STE 403",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244342",
            "telephone_number": "678-765-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 TARA BLVD",
            "address_2": "SUITE D",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "30236",
            "telephone_number": "678-834-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED HEALTH CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-13",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "RODRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-765-2733"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GA",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "CHROME",
            "affiliation": "N",
            "address_1": "950 Scales Rd Ste 403",
            "city": "Suwanee",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300244342",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "CHROME",
            "affiliation": "N",
            "address_1": "950 Scales Rd Ste 403",
            "city": "Suwanee",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300244342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.