Provider Demographics
NPI:1073747002
Name:HEALTHCHOICE CENTER OF PEACHTREE CITY LLC
Entity Type:Organization
Organization Name:HEALTHCHOICE CENTER OF PEACHTREE CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-408-0184
Mailing Address - Street 1:14 EASTBROOK BND # 201
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1530
Mailing Address - Country:US
Mailing Address - Phone:770-408-0184
Mailing Address - Fax:770-632-7747
Practice Address - Street 1:14 EASTBROOK BND # 201
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-408-0184
Practice Address - Fax:770-632-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty