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General NPI Number Information
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NPI Number | 1245451509
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Entity Type | Organization
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Legal Business Name | PEACHTREE MEDICAL AND SURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 02/01/2015
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Provider Practice Location Address
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Address Line | 64 EASTBROOK BND
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1530
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Country | US
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Telephone | 770-487-3272
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Fax | 770-632-7867
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Provider Business Mailing Address
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Address Line | PO BOX 2530
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-0530
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Country | US
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Telephone | 770-487-3272
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Fax | 770-632-7867
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Authorized Official
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Title or Position | PRESIDENT SURGEON
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Name | DR. DON C WALKER
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Credential | MD FACS
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Telephone | 770-487-3272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 024876
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 024876
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License Number State | GA
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