Provider Demographics
NPI:1114240454
Name:PEACHTREE TRANSPORTATION
Entity Type:Organization
Organization Name:PEACHTREE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HEALTHCARE ADMIN
Authorized Official - Phone:404-932-8755
Mailing Address - Street 1:6354 SHANNON PKWY
Mailing Address - Street 2:16 D
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2492
Mailing Address - Country:US
Mailing Address - Phone:404-704-7996
Mailing Address - Fax:
Practice Address - Street 1:6354 SHANNON PKWY
Practice Address - Street 2:16 D
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2492
Practice Address - Country:US
Practice Address - Phone:404-704-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)