Healthcare Provider Details

I. General information

NPI: 1700899754
Provider Name (Legal Business Name): PEACHTREE SPINE & PAIN PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD NE SUITE 201
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD STE G65
ATLANTA GA
30342-1710
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-3323
  • Fax: 404-574-5944
Mailing address:
  • Phone: 404-843-3323
  • Fax: 404-574-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEFFREY S GROSSMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-843-3323