Healthcare Provider Details

I. General information

NPI: 1306754940
Provider Name (Legal Business Name): PEACHES PROCTOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BELLE ISLE CIR NE
ATLANTA GA
30329-2528
US

IV. Provider business mailing address

2480 BRIARCLIFF RD NE STE 6
ATLANTA GA
30329-3008
US

V. Phone/Fax

Practice location:
  • Phone: 678-379-3812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARMEN FRANCES FONG
Title or Position: PRESIDENT
Credential: MD
Phone: 989-750-5180