Provider Demographics
NPI:1346909942
Name:PEACHLAND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:PEACHLAND MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:404-629-7613
Mailing Address - Street 1:1001 VIRGINIA AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1367
Mailing Address - Country:US
Mailing Address - Phone:404-748-6071
Mailing Address - Fax:470-990-7165
Practice Address - Street 1:1001 VIRGINIA AVE STE 314
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1367
Practice Address - Country:US
Practice Address - Phone:404-629-7613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies