Healthcare Provider Details

I. General information

NPI: 1881902575
Provider Name (Legal Business Name): PEACHTREE SPINE & PAIN PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CANTON RD NE STE 200
MARIETTA GA
30060-8949
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD NE STE 201
ATLANTA GA
30342-1711
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 Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number046109
License Number StateGA

VIII. Authorized Official

Name: DR. JEFFREY BENDER
Title or Position: PRESIDENT
Credential: MD
Phone: 404-843-3323