=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124207220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UHS OF PEACHFORD LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2007
-----------------------------------------------------
Last Update Date | 03/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 PEACHFORD RD
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-6534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-455-3200
-----------------------------------------------------
Fax | 770-454-2349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 367 S GULPH RD ATTN. PATTI JONES
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-768-3359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP
-----------------------------------------------------
Name | STEVE FILTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-347-7750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 044-596
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------