Provider Demographics
NPI:1083768691
Name:PEACHTREE GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:PEACHTREE GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WISKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-539-5980
Mailing Address - Street 1:1800 PEACHTREE ST NW
Mailing Address - Street 2:650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2519
Mailing Address - Country:US
Mailing Address - Phone:678-539-5980
Mailing Address - Fax:
Practice Address - Street 1:1800 PEACHTREE ST NW
Practice Address - Street 2:650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2519
Practice Address - Country:US
Practice Address - Phone:678-539-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029013207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508848540OtherINDIV NPI
GA1508848540OtherINDIV NPI
GAE61592Medicare UPIN