# DUE WEST INTEGRATED HEALTH CENTER PHYSICAL MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275819088
- **Authorized official:** DR. JOHN P LANIER M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (770) 429-5555

## Contact information

- **Practice address:** 1600 KENNESAW DUE WEST RD NW, SUITE 501, KENNESAW, GA 30152-4301
- **Practice address phone:** (770) 429-5555
- **Mailing address:** 1600 KENNESAW DUE WEST RD NW STE 501, KENNESAW, GA 30152-4304
- **Mailing address phone:** (770) 429-5555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 28809 | GA | Yes |

## Other

- **Enumeration date:** 10/25/2011
- **Last updated:** 10/25/2011