Provider Demographics
NPI:1164936217
Name:ACWORTH MEDICAL AND RESPITE CARE
Entity Type:Organization
Organization Name:ACWORTH MEDICAL AND RESPITE CARE
Other - Org Name:RAPID CARE MOBILE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-528-8505
Mailing Address - Street 1:605 CEREMONY WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3730
Mailing Address - Country:US
Mailing Address - Phone:404-667-0533
Mailing Address - Fax:
Practice Address - Street 1:605 CEREMONY WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-3730
Practice Address - Country:US
Practice Address - Phone:404-667-0533
Practice Address - Fax:404-667-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center