Provider Demographics
NPI:1821392101
Name:ACWORTH PULMONARY AND SLEEP LLC
Entity Type:Organization
Organization Name:ACWORTH PULMONARY AND SLEEP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-361-4848
Mailing Address - Street 1:4900 IVEY RD NW
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4108
Mailing Address - Country:US
Mailing Address - Phone:678-361-4848
Mailing Address - Fax:
Practice Address - Street 1:4900 IVEY RD NW
Practice Address - Street 2:SUITE 1220
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4108
Practice Address - Country:US
Practice Address - Phone:678-361-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-31
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048833207QS1201X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty