Provider Demographics
NPI:1679048003
Name:PEACHTREE OCCUPATIONAL MEDICINE & URGENT CARE
Entity Type:Organization
Organization Name:PEACHTREE OCCUPATIONAL MEDICINE & URGENT CARE
Other - Org Name:PEACHTREE ORTHOPEDIC OCCUPATIONAL MEDICINE-NORCROSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-350-0743
Mailing Address - Street 1:2001 PEACHTREE RD NE STE 705
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTHSIDE DR NW STE 1400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5479
Practice Address - Country:US
Practice Address - Phone:770-449-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine