# INTEGRATIVE MEDICAL GROUP AND MEDICAL SPA, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Integrative Medical Group and Medical Spa, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417593047
- **Authorized official:** AVA COOPER-CADRES (CEO)
- **Authorized official phone:** (678) 463-1719

## Contact information

- **Practice address:** 805 LAMBERT DR NE STE C, ATLANTA, GA 30324-4189
- **Practice address phone:** (678) 561-3023
- **Mailing address:** 805 LAMBERT DR NE STE C, ATLANTA, GA 30324-4189
- **Mailing address phone:** (678) 561-3023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/19/2019
- **Last updated:** 11/19/2019