Provider Demographics
NPI:1881262673
Name:INTEGRITY DIAGNOSTIC NETWORK, LLC
Entity type:Organization
Organization Name:INTEGRITY DIAGNOSTIC NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DSC
Authorized Official - Phone:470-809-1581
Mailing Address - Street 1:3 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1625
Mailing Address - Country:US
Mailing Address - Phone:470-809-1581
Mailing Address - Fax:
Practice Address - Street 1:140 JOHNNY MERCER BLVD STE 10A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2169
Practice Address - Country:US
Practice Address - Phone:470-809-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty