Provider Demographics
NPI:1629410154
Name:PEACHTREE CITY OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:PEACHTREE CITY OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-487-9604
Mailing Address - Street 1:775 POPLAR RD.
Mailing Address - Street 2:SUITE 360
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8304
Mailing Address - Country:US
Mailing Address - Phone:770-487-9604
Mailing Address - Fax:678-673-5090
Practice Address - Street 1:775 POPLAR RD.
Practice Address - Street 2:SUITE 360
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8304
Practice Address - Country:US
Practice Address - Phone:770-487-9604
Practice Address - Fax:678-673-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty