Organization
INTEGRATED HEALTH CENTER OF GA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OTIS SAMUEL POWELL JR. M.D. (MEDICAL DIRECTOR)
(470) 326-5750
Entity
Organization
Contact information
Practice address
1400 BUFORD HWY, SUITE K2, BUFORD, GA 30518-8721
(470) 326-5750
Mailing address
1400 BUFORD HWY, SUITE K2, BUFORD, GA 30518-8721
(470) 326-5750
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/04/2016
Last updated
11/08/2016
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