Provider Demographics
NPI:1275883464
Name:PEACHTREE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PEACHTREE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-580-2587
Mailing Address - Street 1:7742 SPALDING DR STE 115
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4207
Mailing Address - Country:US
Mailing Address - Phone:678-580-2587
Mailing Address - Fax:
Practice Address - Street 1:7742 SPALDING DR STE 115
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4207
Practice Address - Country:US
Practice Address - Phone:678-580-2587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147191163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty