Basic Information
| Provider Information | |||||||||
| NPI: | 1487605671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACUFF | ||||||||
| FirstName: | COLM | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6896 W SNOWVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441413214 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1455 BATTERSBY AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123503849 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 56255 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OP60931223 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | BA8471853 | 01 | GA | DEA | OTHER | 657255344A | 01 | GA | PEACH STATE HEALTH PLAN | OTHER | 967531 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER | G56255 | 05 | SC | MEDICAID | N362160 | 01 | GA | WELLCARE | OTHER | 657255344A | 05 | GA | MEDICAID |