Provider Demographics
NPI:1609541457
Name:PEACHTREE NEPHROLOGY CONSULTANTS LLC
Entity Type:Organization
Organization Name:PEACHTREE NEPHROLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GYEBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-337-6717
Mailing Address - Street 1:3338 PEACHTREE RD NE APT 3402
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1473
Mailing Address - Country:US
Mailing Address - Phone:404-467-6400
Mailing Address - Fax:404-467-6402
Practice Address - Street 1:3338 PEACHTREE RD NE APT 3402
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1473
Practice Address - Country:US
Practice Address - Phone:404-467-6400
Practice Address - Fax:404-467-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty