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General NPI Number Information
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NPI Number | 1487950275
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Entity Type | Organization
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Legal Business Name | PEACHTREE SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 7742 SPALDING DR STE 115
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City | NORCROSS
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State | GA
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Zip | 30092-4207
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Country | US
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Telephone | 678-691-6529
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Fax | 770-840-7464
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Provider Business Mailing Address
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Address Line | 7742 SPALDING DR STE 115
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City | NORCROSS
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State | GA
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Zip | 30092-4207
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Country | US
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Telephone | 678-691-6529
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Fax | 770-840-7464
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN WALKER
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Credential | CSA, CFA
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Telephone | 678-691-6529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | F01331
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 238.000137
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | F01331
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License Number State | GA
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