Provider Demographics
NPI:1235354218
Name:ACWORTH PAIN MANAGEMENT CENTER INC
Entity Type:Organization
Organization Name:ACWORTH PAIN MANAGEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MERRICK
Authorized Official - Last Name:STURRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-388-7778
Mailing Address - Street 1:5399 BELLS FERRY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7546
Mailing Address - Country:US
Mailing Address - Phone:678-388-7778
Mailing Address - Fax:678-388-7779
Practice Address - Street 1:5399 BELLS FERRY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7546
Practice Address - Country:US
Practice Address - Phone:678-388-7778
Practice Address - Fax:678-388-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7293Medicare ID - Type UnspecifiedLEGACY PIN