Healthcare Provider Details

I. General information

NPI: 1245451509
Provider Name (Legal Business Name): PEACHTREE MEDICAL AND SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 EASTBROOK BND
PEACHTREE CITY GA
30269-1530
US

IV. Provider business mailing address

PO BOX 2530
PEACHTREE CITY GA
30269-0530
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-3272
  • Fax: 770-632-7867
Mailing address:
  • Phone: 770-487-3272
  • Fax: 770-632-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number024876
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number024876
License Number StateGA

VIII. Authorized Official

Name: DR. DON C WALKER
Title or Position: PRESIDENT SURGEON
Credential: MD FACS
Phone: 770-487-3272