Organization
INTERVENTIONAL INSTITUTE OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY DANIELLE FARROW BS (CLINICAL COORDINATOR)
(770) 820-9222
Entity
Organization
Contact information
Practice address
7130 MOUNT ZION BLVD, SUITE 2, JONESBORO, GA 30236-2566
(770) 506-4007
(678) 246-5191
Mailing address
PO BOX 955, STOCKBRIDGE, GA 30281-0955
(770) 506-4007
(678) 246-5191
Taxonomy
Speciality
Code
Description
License number
State
213ER0200X
Radiology Podiatrist
Primary
043894
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000757314H
—
GA
Enumeration date
04/01/2014
Last updated
04/01/2014
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