Organization
ACWORTH IMMEDIATE CARE LLC
Active
Other names
Acworth Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DUNCAN (VP)
(615) 373-5135
Entity
Organization
Contact information
Practice address
4450 CALIBRE CROSSING, SUITE 1104, ACWORTH, GA 30101
(770) 975-6540
(770) 975-6541
Mailing address
4450 CALIBRE CROSSING, SUITE 1104, ACWORTH, GA 30101
(770) 975-6540
(770) 975-6541
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52230468001
BCBS OF GA
GA
05
—
842071171A
—
GA
Enumeration date
03/11/2008
Last updated
08/26/2008
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