Provider Demographics
NPI:1598544306
Name:PEACHTREE OMFS LLC, DBN PEACHTREE ORAL & FACIAL SURGERY
Entity Type:Organization
Organization Name:PEACHTREE OMFS LLC, DBN PEACHTREE ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-302-0101
Mailing Address - Street 1:262 S PEACHTREE PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1752
Mailing Address - Country:US
Mailing Address - Phone:770-302-0101
Mailing Address - Fax:770-302-0105
Practice Address - Street 1:262 S PEACHTREE PKWY STE 1
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1752
Practice Address - Country:US
Practice Address - Phone:770-302-0101
Practice Address - Fax:770-302-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty