Healthcare Provider Details

I. General information

NPI: 1013296078
Provider Name (Legal Business Name): PEACHTREE SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PEACHTREE ST NE STE 160
ATLANTA GA
30309-3000
US

IV. Provider business mailing address

1401 PEACHTREE ST NE STE 160
ATLANTA GA
30309-3000
US

V. Phone/Fax

Practice location:
  • Phone: 404-475-0386
  • Fax: 404-475-0443
Mailing address:
  • Phone: 404-475-0386
  • Fax: 404-475-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberCHIR005228
License Number StateGA

VIII. Authorized Official

Name: MS. SARA BADIE
Title or Position: BILLING
Credential:
Phone: 770-876-6964