Basic Information
| Provider Information | |||||||||
| NPI: | 1730348178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEACH EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 SW 78TH AVE | ||||||||
| Address2: | # 100-B | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
| FaxNumber: | 9546256034 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 BLUEBIRD BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT VALLEY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310305082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4788258691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHILLINGER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8776935700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.