Provider Demographics
NPI:1245422641
Name:INNOVATIVE HEALTH CENTERS, LLC
Entity type:Organization
Organization Name:INNOVATIVE HEALTH CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MED DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-455-5816
Mailing Address - Street 1:11877 DOUGLAS RD
Mailing Address - Street 2:STE 102-271
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4325
Mailing Address - Country:US
Mailing Address - Phone:866-455-5816
Mailing Address - Fax:
Practice Address - Street 1:11877 DOUGLAS RD
Practice Address - Street 2:STE 102-271
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4325
Practice Address - Country:US
Practice Address - Phone:866-455-5816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty