Provider Demographics
NPI:1811135916
Name:PEACHTREE ORTHOPAEDIC CLINIC
Entity type:Organization
Organization Name:PEACHTREE ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:404-350-4703
Mailing Address - Street 1:PO BOX 105258
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-5258
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:
Practice Address - Street 1:3870 PLEASANT HILL RD
Practice Address - Street 2:SUITE #1
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4807
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1381Medicare PIN
GA6304470002Medicare NSC