Provider Demographics
NPI:1972253243
Name:PEACHPOINT CLINIC
Entity type:Organization
Organization Name:PEACHPOINT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-904-4500
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0508
Mailing Address - Country:US
Mailing Address - Phone:678-904-4500
Mailing Address - Fax:678-904-4884
Practice Address - Street 1:2914 VINSON CT
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3505
Practice Address - Country:US
Practice Address - Phone:678-904-4500
Practice Address - Fax:678-904-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty