Provider Demographics
NPI:1972888139
Name:PEACHSTATE HEALTH MANAGEMENT LLC
Entity type:Organization
Organization Name:PEACHSTATE HEALTH MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-276-8412
Mailing Address - Street 1:2225 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5760
Mailing Address - Country:US
Mailing Address - Phone:678-276-8411
Mailing Address - Fax:678-971-4830
Practice Address - Street 1:2225 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5760
Practice Address - Country:US
Practice Address - Phone:678-276-8412
Practice Address - Fax:678-971-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory