NPI 1104967850

Integrated-Activhealthcare, LLC

Organisation Preferred Provider Organization Lilburn, GA

Practice location

Address: 4566 Lawrenceville Hwy NW, Lilburn, GA 30047-3618
Phone: (770) 455-0040
Fax: (770) 455-6188
Mailing address: PO Box 969, Lilburn, GA 30048-0969

Authorised official

Name: Mark Brickhouse
Title: Director of Operations
Phone: (770) 455-0040

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1104967850
Entity type: Organization
NPI issued: 8 Feb 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.