| |
4791 S Main St Acworth GA 30101-5324 | |
(770) 422-1400 | |
(678) 290-6728 |
Full Name | |
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Speciality | Family Medicine |
Location | 4791 S Main St, Acworth, Georgia |
Authorized Official Name and Position | Connie H. Keller (OFFICE MANAGER) |
Authorized Official Contact | 7704221400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4791 S Main St Acworth GA 30101-5324 Ph: (770) 422-1400 | 4791 S Main St Acworth GA 30101-5324 Ph: (770) 422-1400 |
NPI Number | 1881730455 |
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Provider Enumeration Date | 01/30/2007 |
Last Update Date | 10/22/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881730455 | NPI | - | NPPES |
085000643G | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 581584420 (Georgia) | Primary |
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