Active NPI
Integrative Health PC
- Psychiatry Physician
- Valdosta, GA
National Provider Identifier
1962780171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 54448
- Legal business name
- INTEGRATIVE HEALTH PC
- Practice address
- 2935 N Ashley St
Suite 114
Valdosta, GA 31602-1777 - Phone
- (229) 219-1831
- NPI assigned
- Jul 22, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Tiffany Michelle Kumpel, MD
- Title
- President
- Phone
- (229) 333-9632
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 54448 | GA | Primary |
Addresses
Primary practice location
2935 N Ashley St
Suite 114
Valdosta, GA 31602-1777
Mailing address
2935 N Ashley St Ste 114
Valdosta, GA 31602-1788
Phone (229) 219-1831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110930000418 | GA | Part B Supplier - Clinic/Group Practice | 7719159441 |
Receives reassigned benefits from 1 practitioner Practice locations: Valdosta, GA |
National Provider Directory
National Provider DirectoryLocations
116 W Thigpen Ave
Ste A
Lakeland, GA 31635
Phone (229) 219-1831
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311292800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1330473600000",
"number": "1962780171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2935 N ASHLEY ST STE 114",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021788",
"telephone_number": "229-219-1831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2935 N ASHLEY ST",
"address_2": "SUITE 114",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021777",
"telephone_number": "229-219-1831"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTEGRATIVE HEALTH PC",
"organizational_subpart": "NO",
"enumeration_date": "2011-07-22",
"last_updated": "2012-02-29",
"status": "A",
"authorized_official_last_name": "KUMPEL",
"authorized_official_first_name": "TIFFANY",
"authorized_official_middle_name": "MICHELLE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "229-333-9632",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "54448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.