Healthcare Provider Details

I. General information

NPI: 1982195061
Provider Name (Legal Business Name): AWC NETWORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 PEACHTREE ST NE STE 100010TH
ATLANTA GA
30361-3528
US

IV. Provider business mailing address

PO BOX 56833
ATLANTA GA
30343-0833
US

V. Phone/Fax

Practice location:
  • Phone: 404-946-1820
  • Fax: 404-973-0231
Mailing address:
  • Phone: 404-946-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. APRYL ESPINOZA-WADE
Title or Position: BILLING MANAGER
Credential:
Phone: 678-964-5234