How do I submit a change of address or location change?

To change your address, it is necessary to complete the Provider Information Form, Location Information Form, and a W-9 form. The forms are also available in the credentialing documents

You may fax the completed forms to 770-455-6188 or mail to:

    Integrated-ActivHealthCare
    P. O. Box 969
    Lilburn, GA 30048