| Lake Acworth Family Practice | |
|
5655 Lake Acworth Dr Nw Ste 120 Acworth GA 30101-7324 | |
| (770) 702-8408 | |
| Not Available |
| Full Name | Lake Acworth Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 5655 Lake Acworth Dr Nw Ste 120, Acworth, Georgia |
| Authorized Official Name and Position | Naomi W Muhia (NURSE PRACTITIONER) |
| Authorized Official Contact | 4043536317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Acworth Family Practice 5655 Lake Acworth Dr Nw Ste 120 Acworth GA 30101-7324 Ph: (770) 702-8408 | Lake Acworth Family Practice 5655 Lake Acworth Dr Nw Ste 120 Acworth GA 30101-7324 Ph: (770) 702-8408 |
| NPI Number | 1386052736 |
|---|---|
| Provider Enumeration Date | 07/30/2014 |
| Last Update Date | 03/19/2015 |
| Medicare PECOS PAC ID | 3577987213 |
|---|---|
| Medicare Enrollment ID | O20200728000940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386052736 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | RN16397 (Georgia) | Primary |
| Provider Name | Adeshola Adewunmi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285819821 PECOS PAC ID: 6204022510 Enrollment ID: I20101129001061 |
| Provider Name | Naomi W Muhia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831331297 PECOS PAC ID: 4789733676 Enrollment ID: I20111006000200 |
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