Healthcare Provider Details

I. General information

NPI: 1982486122
Provider Name (Legal Business Name): PEACHTREE WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PEACHTREE INDUSTRIAL BLVD STE 4108
SUWANEE GA
30024-4541
US

IV. Provider business mailing address

1300 PEACHTREE INDUSTRIAL BLVD STE 4108
SUWANEE GA
30024-4541
US

V. Phone/Fax

Practice location:
  • Phone: 470-238-3683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TONY CHUNG
Title or Position: CHIEF CLINICAL DIRECTOR
Credential:
Phone: 470-238-3683