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General NPI Number Information
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NPI Number | 1558770503
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Entity Type | Organization
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Legal Business Name | MEDPEACH CONSULTING, LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 931 LOWER FAYETTEVILLE RD SUITE J
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City | NEWNAN
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State | GA
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Zip | 30263-5790
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Country | US
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Telephone | 770-683-4772
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Fax | 888-235-9876
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Provider Business Mailing Address
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Address Line | 931 LOWER FAYETTEVILLE RD SUITE J
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City | NEWNAN
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State | GA
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Zip | 30263-5790
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Country | US
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Telephone | 770-683-4772
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Fax | 888-235-9876
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MR. VICKY ENN
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Credential | D.O
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Telephone | 863-232-5062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8157
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License Number State | GA
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