Provider Demographics
NPI:1598185548
Name:ACSH PRIMARY CARE OF GEORGIA, LLC
Entity Type:Organization
Organization Name:ACSH PRIMARY CARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-465-1000
Mailing Address - Street 1:PO BOX 101047
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30392-1047
Mailing Address - Country:US
Mailing Address - Phone:404-465-1000
Mailing Address - Fax:678-828-8061
Practice Address - Street 1:4861 BILL GARDNER PKWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3644
Practice Address - Country:US
Practice Address - Phone:770-626-5740
Practice Address - Fax:770-626-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care