Provider Demographics
NPI:1598464661
Name:ACME HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:ACME HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AIBANGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-451-3341
Mailing Address - Street 1:5579 CHAMBLEE DUNWOODY RD STE B
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4100
Mailing Address - Country:US
Mailing Address - Phone:678-509-6060
Mailing Address - Fax:
Practice Address - Street 1:5579 CHAMBLEE DUNWOODY RD STE B
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4100
Practice Address - Country:US
Practice Address - Phone:678-509-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty