MEDICARE: PEACHLAND MEDICAL SUPPLY INC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1346909942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHLAND MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	1001 VIRGINIA AVE STE 314
Second Line	:
City	:	HAPEVILLE
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:	404-748-6071
Fax Number	:	470-990-7165

Provider Business Practice Location Address
First Line	:	1001 VIRGINIA AVE STE 314
Second Line	:
City	:	HAPEVILLE
State	:	GA
Zip	:	30354-1367
Country	:	US
Telephone Number	:	404-629-7613
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN CALVIN WILLIAMS III
Credential	:
Telephone Number	:	404-629-7613

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	03/04/2025

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