Basic Information
| Provider Information | |||||||||
| NPI: | 1235678483 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEACHTREE ORTHOPAEDIC CLINIC, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 DOWNWOOD CIR NW | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303271610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | CHIARAVALLOTI | ||||||||
| AuthorizedOfficialFirstName: | SARANYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4043502447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.