Organization
INTEGRATED-ACTIVHEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BRICKHOUSE (DIRECTOR OF OPERATIONS)
(770) 455-0040
Entity
Organization
Contact information
Practice address
4566 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3618
(770) 455-0040
(770) 455-6188
Mailing address
PO BOX 969, LILBURN, GA 30048-0969
(770) 455-0040
(770) 455-6188
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
02/08/2007
Last updated
08/22/2020
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