MEDICARE: PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PIEDMONT 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	207X00000X	Orthopaedic Surgery Physician	086261LGB	GA

General Provider Information

NPI Number	:	1902861941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PIEDMONT LLC

Provider Business Mailing Address
First Line	:	77 COLLIER RD
Second Line	:	SUITE 2000
City	:	ATLANTA
State	:	GA
Zip	:	30309-1754
Country	:	US
Telephone Number	:	404-351-6393
Fax Number	:	404-367-8259

Provider Business Practice Location Address
First Line	:	77 COLLIER RD
Second Line	:	SUITE 2000
City	:	ATLANTA
State	:	GA
Zip	:	30309-1754
Country	:	US
Telephone Number	:	404-351-6393
Fax Number	:	404-367-8259

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHERYL L FIELDER
Credential	:
Telephone Number	:	404-351-6393

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/22/2020

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