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NPI Code Detail

MEDICARE: PEACHTREE FAYETTE WOMEN'S SPECIALISTS

MEDICARE: PEACHTREE FAYETTE WOMEN'S SPECIALISTS
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician20002063GA

General Provider Information

NPI Number : 1164475703
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEACHTREE FAYETTE WOMEN'S SPECIALISTS
Provider Business Mailing Address
First Line : 1267 HIGHWAY 54 W
Second Line : SUITE 3200
City : FAYETTEVILLE
State : GA
Zip : 30214-4526
Country : US
Telephone Number : 770-632-9900
Fax Number : 770-632-9997
Provider Business Practice Location Address
First Line : 1267 HIGHWAY 54 W
Second Line : SUITE 3200
City : FAYETTEVILLE
State : GA
Zip : 30214-4526
Country : US
Telephone Number : 770-632-9900
Fax Number : 770-632-9997
Authorized Official
Title or Position : R.N., PRACTICE MANAGER
Name : MICHELE R BRANDT
Credential : RN
Telephone Number : 770-632-9900
Provider Enumeration Date : 05/17/2006
Last Update Date : 10/02/2012

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Practice Location Address:
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Directions to “PEACHTREE FAYETTE WOMEN'S SPECIALISTS ” Practice Location

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