MEDICARE: ACME HEALTH NETWORK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1598464661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACME HEALTH NETWORK LLC

Provider Business Mailing Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-509-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5579 CHAMBLEE DUNWOODY RD STE B
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4100
Country	:	US
Telephone Number	:	678-509-6060
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KRISTINE AIBANGBEE
Credential	:
Telephone Number	:	470-451-3341

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	05/28/2024

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Directions to “ACME HEALTH NETWORK LLC ” Practice Location

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