Provider Demographics
NPI:1033531769
Name:SUPERIOR HEALTHCARE OF ACWORTH, LLC
Entity Type:Organization
Organization Name:SUPERIOR HEALTHCARE OF ACWORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-214-0100
Mailing Address - Street 1:5505 BELLS FERRY RD
Mailing Address - Street 2:BUILDING 300
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7527
Mailing Address - Country:US
Mailing Address - Phone:678-214-0010
Mailing Address - Fax:678-214-0124
Practice Address - Street 1:5505 BELLS FERRY RD
Practice Address - Street 2:BUILDING 300
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7527
Practice Address - Country:US
Practice Address - Phone:678-214-0010
Practice Address - Fax:678-214-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC20130000880208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty