Organization
INTEGRATED TELEHEALTH LLC
Active
Parent organization
INTEGRATED TELEHEALTH LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTEGRATED TELEHEALTH LLC
Authorized official
DR. JON C GIBBS MD (DIRECTOR)
(706) 831-0204
Entity
Organization
Contact information
Practice address
1523 OLD VALDOSTA RD STE B, RAY CITY, GA 31645
(877) 543-7221
(877) 755-2212
Mailing address
1523 OLD VALDOSTA RD STE B, RAY CITY, GA 31645-7132
(877) 543-7221
(877) 755-2212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000616624F
—
GA
05
—
G38493
—
SC
Enumeration date
07/31/2017
Last updated
08/16/2018
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