MEDICARE: PEACHTREE NEPHROLOGY CONSULTANTS LLC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1609541457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE NEPHROLOGY CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	3338 PEACHTREE RD NE APT 3402
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1473
Country	:	US
Telephone Number	:	404-467-6400
Fax Number	:	404-467-6402

Provider Business Practice Location Address
First Line	:	3338 PEACHTREE RD NE APT 3402
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1473
Country	:	US
Telephone Number	:	404-467-6400
Fax Number	:	404-467-6402

Authorized Official
Title or Position	:	ORGANIZER
Name	:	LEONARD GYEBI
Credential	:	MD
Telephone Number	:	323-337-6717

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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