Provider Demographics
NPI:1316965213
Name:PEACHTREE DERMATOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:PEACHTREE DERMATOLOGY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:STURM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-355-1919
Mailing Address - Street 1:371 E PACES FERRY RD NE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3291
Mailing Address - Country:US
Mailing Address - Phone:404-355-1919
Mailing Address - Fax:404-352-5669
Practice Address - Street 1:371 E PACES FERRY RD NE STE 900
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3291
Practice Address - Country:US
Practice Address - Phone:404-355-1919
Practice Address - Fax:404-352-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP915Medicare ID - Type Unspecified