Provider Demographics
NPI:1740403690
Name:PEACHLAND NEPHROLOGY & HYPERTENSION,PC
Entity Type:Organization
Organization Name:PEACHLAND NEPHROLOGY & HYPERTENSION,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEGA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEHAWARIAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-944-8494
Mailing Address - Street 1:6300 POWERS FERRY RD NW
Mailing Address - Street 2:SUITE 600-112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2919
Mailing Address - Country:US
Mailing Address - Phone:770-944-8494
Mailing Address - Fax:678-945-7401
Practice Address - Street 1:1668 MULKEY RD
Practice Address - Street 2:SUITE G
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1143
Practice Address - Country:US
Practice Address - Phone:770-944-8494
Practice Address - Fax:678-945-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051570207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6502Medicare ID - Type Unspecified
GAH67488Medicare UPIN