NPIMap

Organization Active NPI

Integrated Medical of Georgia, LLC

  • General Practice Physician
  • Marietta, GA
National Provider Identifier
1801405998
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED MEDICAL OF GEORGIA, LLC
Practice address
596 Seminole Dr NE
Marietta, GA 30060-1508
Phone
(770) 428-4909
NPI assigned
Jul 24, 2020
Last updated
Jul 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Authorized official

Name
Enrique CrespoNPI 1396883872
Title
Clinic Administrator
Phone
(770) 428-4909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

596 Seminole Dr NE
Marietta, GA 30060-1508

Mailing address

596 Seminole Dr NE
Marietta, GA 30060-1508
Phone (770) 428-4909

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1801405998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 SEMINOLE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601508",
            "telephone_number": "770-428-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 SEMINOLE DR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601508",
            "telephone_number": "770-428-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "CRESPO",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "770-428-4909"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.