MEDICARE: PEACHTREE ORTHOPAEDIC CLINIC OF GEORGIA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	207XX0801X	Orthopaedic Trauma Physician
4	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
5	207XP3100X	Pediatric Orthopaedic Surgery Physician
6	207XS0106X	Orthopaedic Hand Surgery Physician
7	207XS0117X	Orthopaedic Surgery of the Spine Physician
8	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
9	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1033943105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE ORTHOPAEDIC CLINIC OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	3200 DOWNWOOD CIR NW FL 7
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1610
Country	:	US
Telephone Number	:	215-873-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 RIVER PL STE 200
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5614
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	833-450-5581

Authorized Official
Title or Position	:	REV CYCLE LEADER
Name	:	JOI M KING
Credential	:
Telephone Number	:	215-873-4811

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	03/23/2026

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