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General NPI Number Information
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NPI Number | 1255504924
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Entity Type | Organization
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Legal Business Name | PEACHTREE ENT & FACIAL PLASTICS PA
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 145 MEDICAL PARK LANE SUITE J
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City | MURPHY
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State | NC
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Zip | 28906-6663
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Country | US
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Telephone | 828-837-3223
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Fax | 828-837-7706
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Provider Business Mailing Address
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Address Line | 145 MEDICAL PARK LANE SUITE J
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City | MURPHY
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State | NC
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Zip | 28906-6663
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Country | US
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Telephone | 828-837-3223
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Fax | 828-837-7706
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. RICHARD TODD WEISENBURGER
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Credential | D.O.
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Telephone | 828-837-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2007-01919
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 2007-01919
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License Number State | NC
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