MEDICARE: PEACHTREE REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1053282343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE REHAB

Provider Business Mailing Address
First Line	:	400 INTERSTATE NORTH PKWY SE STE 1125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 INTERSTATE NORTH PKWY SE STE 1125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5087
Country	:	US
Telephone Number	:	678-528-1334
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK LIPSCHITZ
Credential	:
Telephone Number	:	678-400-4878

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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