Provider Demographics
NPI:1164819405
Name:SMYRNA INTEGRATED HEALTH
Entity type:Organization
Organization Name:SMYRNA INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-773-8936
Mailing Address - Street 1:545 CONCORD ROAD SOUTH EAST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:770-432-9290
Mailing Address - Fax:
Practice Address - Street 1:545 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2609
Practice Address - Country:US
Practice Address - Phone:770-432-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty