Provider Demographics
NPI:1215366489
Name:PEACHTREE ORTHOPAEDIC CLINIC, PC
Entity Type:Organization
Organization Name:PEACHTREE ORTHOPAEDIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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 300
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7623
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:855-283-8851
Practice Address - Street 1:2860 RONALD REAGAN BLVD., STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7623
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:855-283-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies