Basic Information
| Provider Information | |||||||||
| NPI: | 1154569127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEACHTREE ORTHOPAEDIC CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 105258 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303485258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 PHOENIX BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLLEGE PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | SEATON | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4043504703 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.