Provider Demographics
NPI:1881192946
Name:PEACHTREE CITY ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:PEACHTREE CITY ACUPUNCTURE, INC.
Other - Org Name:ASHEVILLE FUNCTIONAL MEDICINE & ACUPUNCTURE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-756-1979
Mailing Address - Street 1:4000 SHAKERAG HL STE 300
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4047
Mailing Address - Country:US
Mailing Address - Phone:770-756-1979
Mailing Address - Fax:855-393-9876
Practice Address - Street 1:4000 SHAKERAG HL STE 300
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4047
Practice Address - Country:US
Practice Address - Phone:770-756-1979
Practice Address - Fax:855-393-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty