MEDICARE: PEACHTREE DERMATOLOGY ASSOCIATES, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1316965213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE DERMATOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	371 E PACES FERRY RD NE STE 900
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-3291
Country	:	US
Telephone Number	:	404-355-1919
Fax Number	:	404-352-5669

Provider Business Practice Location Address
First Line	:	371 E PACES FERRY RD NE STE 900
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-3291
Country	:	US
Telephone Number	:	404-355-1919
Fax Number	:	404-352-5669

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	RICHARD LOWELL STURM
Credential	:	M.D.
Telephone Number	:	404-355-1919

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/04/2019

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