Provider Demographics
NPI:1285786541
Name:ACWORTH FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:ACWORTH FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-354-0230
Mailing Address - Street 1:5150 STILESBORO RD NW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7744
Mailing Address - Country:US
Mailing Address - Phone:678-354-0230
Mailing Address - Fax:678-354-0828
Practice Address - Street 1:5150 STILESBORO RD NW
Practice Address - Street 2:SUITE 120
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7744
Practice Address - Country:US
Practice Address - Phone:678-354-0230
Practice Address - Fax:678-354-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040714261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA160227OtherCOVENTRY HEALTHCARE OF GA
GA759253OtherBLUECROSS BLUESHIELD GA
GA1775856OtherUNITED HEALTHCARE
GA9289602OtherCIGNA HEALTHCARE
GA1775856OtherUNITED HEALTHCARE
GAG2110Medicare UPIN