Provider Demographics
NPI:1457443137
Name:PEACHTREE NEUROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEACHTREE NEUROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-255-5330
Mailing Address - Street 1:PO BOX 420297
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0297
Mailing Address - Country:US
Mailing Address - Phone:404-255-5330
Mailing Address - Fax:404-255-5416
Practice Address - Street 1:5730 GLENRIDGE DR STE 220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5579
Practice Address - Country:US
Practice Address - Phone:404-255-5330
Practice Address - Fax:404-255-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0334422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2400Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER