Integrated Health Center of Ga, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

INTEGRATED HEALTH CENTER OF GA, LLC

Practice address

1400 Buford Hwy
Suite K2
Buford, GA 30518-8721

Phone

(470) 326-5750

NPI assigned

Oct 4, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Otis Samuel Powell Jr., M.D.

Title

Medical Director

Phone

(470) 326-5750

Specialties & licenses 1

Addresses

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 Corp

  • Mental Health Counselor
  • Jonesboro, GA
  • NPI 1336505809
  NPD tax ID

Locations

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1972053866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BUFORD HWY",
            "address_2": "SUITE K2",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305188721",
            "telephone_number": "470-326-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BUFORD HWY",
            "address_2": "SUITE K2",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305188721",
            "telephone_number": "470-326-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED HEALTH CENTER OF GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "470-326-5750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Buford, GA
• Providers in Buford, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; 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.