Provider Demographics
NPI:1093389421
Name:PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC
Entity Type:Organization
Organization Name:PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-0743
Mailing Address - Street 1:2860 RONALD REAGAN BLVD.
Mailing Address - Street 2:STE 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:404-425-1500
Mailing Address - Fax:
Practice Address - Street 1:2860 RONALD REAGAN BLVD.
Practice Address - Street 2:STE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:404-425-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical