Provider Demographics
NPI:1477573293
Name:ATLANTA PRIMARY CARE PEACHTREE, PC
Entity Type:Organization
Organization Name:ATLANTA PRIMARY CARE PEACHTREE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-487-0556
Mailing Address - Street 1:51 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1209
Mailing Address - Country:US
Mailing Address - Phone:770-251-5540
Mailing Address - Fax:770-487-9974
Practice Address - Street 1:51 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1209
Practice Address - Country:US
Practice Address - Phone:770-251-5540
Practice Address - Fax:702-251-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0225609OtherCIGNA
GA52841180OtherBCBSGA
GA7275373GOtherAETNA
GA52841180OtherBCBSGA
GA7275373GOtherAETNA