MEDICARE: PEACHTREE ENDODONTICS, P.C.

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	1223E0200X	Endodontics	DN012892	GA

General Provider Information

NPI Number	:	1992729552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE ENDODONTICS, P.C.

Provider Business Mailing Address
First Line	:	1401 GEORGIAN PARK
Second Line	:	SUITE 100
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-6973
Country	:	US
Telephone Number	:	770-631-2728
Fax Number	:	770-631-2714

Provider Business Practice Location Address
First Line	:	1401 GEORGIAN PARK
Second Line	:	SUITE 100
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-6973
Country	:	US
Telephone Number	:	770-631-2728
Fax Number	:	770-631-2714

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. GEORGE BROWN JR.
Credential	:	D.M.D.,M.S.D.
Telephone Number	:	770-631-2728

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/28/2013

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