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General NPI Number Information
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NPI Number | 1386097913
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Entity Type | Organization
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Legal Business Name | GEORGIA PEACH HEALTH CARE
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 6909 TARA BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1503
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Country | US
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Telephone | 404-992-9130
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Fax |
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Provider Business Mailing Address
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Address Line | 3069 AMWILER RD SUITE 2
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City | ATLANTA
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State | GA
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Zip | 30360-2825
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Country | US
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Telephone | 404-992-9130
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DR. JOHN SALINAS
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Credential | MD
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Telephone | 404-992-9130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 038600
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 038600
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 038600
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License Number State | GA
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