Provider Demographics
NPI:1629130851
Name:PEACHTREE VASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEACHTREE VASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SKARDASIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-681-3190
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1085
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-681-3190
Mailing Address - Fax:404-681-3193
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1085
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2232
Practice Address - Country:US
Practice Address - Phone:404-681-3190
Practice Address - Fax:404-681-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00053633AMedicaid
GA578663OtherAETNA
GA1013082387OtherNPI
GA17-05841OtherHEALTH FIRST
GA253729461OtherCHAMPUS
GA020044829OtherMEDICARE RAILROAD
GA212200OtherBLUE CROSS BLUE SHIELD
GAGRP1615OtherMEDICARE
GA1013082387OtherNPI
GA=========OtherCIGNA