Healthcare Provider Details

I. General information

NPI: 1235678483
Provider Name (Legal Business Name): PEACHTREE ORTHOPAEDIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW SUITE 700
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax: 404-355-2136
Mailing address:
  • Phone: 404-355-0743
  • Fax: 404-355-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SARANYA CHIARAVALLOTI
Title or Position: DIRECTOR OF REVENUE SERVICES
Credential:
Phone: 404-350-2447