Provider Demographics
NPI:1215978143
Name:PHYSICIANS IMMEDIATE MED OF PEACHTREE CORNERS, P.C.
Entity type:Organization
Organization Name:PHYSICIANS IMMEDIATE MED OF PEACHTREE CORNERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-263-1000
Mailing Address - Street 1:3720 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4795
Mailing Address - Country:US
Mailing Address - Phone:770-263-1000
Mailing Address - Fax:770-263-7770
Practice Address - Street 1:3720 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4795
Practice Address - Country:US
Practice Address - Phone:770-263-1000
Practice Address - Fax:770-263-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty