Healthcare Provider Details

I. General information

NPI: 1144458266
Provider Name (Legal Business Name): PHYSICIANS IMMEDIATE MED OF ACWORTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 COBB PARKWAY NW
ACWORTH GA
30101
US

IV. Provider business mailing address

3540 COBB PARKWAY NW
ACWORTH GA
30101
US

V. Phone/Fax

Practice location:
  • Phone: 770-974-3911
  • Fax: 770-405-0606
Mailing address:
  • Phone: 770-974-3911
  • Fax: 770-405-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PAFUMY
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 770-974-3911