Provider Demographics
NPI:1699835660
Name:PEACHTREE PARK PEDIATRICS, LLP
Entity Type:Organization
Organization Name:PEACHTREE PARK PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.,PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WISKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-351-1131
Mailing Address - Street 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-351-1131
Mailing Address - Fax:404-351-3515
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-351-1131
Practice Address - Fax:404-351-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty