Provider Demographics
NPI:1164475703
Name:PEACHTREE FAYETTE WOMEN'S SPECIALISTS
Entity Type:Organization
Organization Name:PEACHTREE FAYETTE WOMEN'S SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N., PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-632-9900
Mailing Address - Street 1:1267 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4526
Mailing Address - Country:US
Mailing Address - Phone:770-632-9900
Mailing Address - Fax:770-632-9997
Practice Address - Street 1:1267 HIGHWAY 54 W
Practice Address - Street 2:SUITE 3200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-632-9900
Practice Address - Fax:770-632-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20002063207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty