Provider Demographics
NPI:1902861941
Name:PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PIEDMONT LLC
Entity Type:Organization
Organization Name:PEACHTREE ORTHOPAEDIC SURGERY CENTER AT PIEDMONT LLC
Other - Org Name:PEACHTREE ORTHOPEADIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-6393
Mailing Address - Street 1:77 COLLIER RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1754
Mailing Address - Country:US
Mailing Address - Phone:404-351-6393
Mailing Address - Fax:404-367-8259
Practice Address - Street 1:77 COLLIER RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1754
Practice Address - Country:US
Practice Address - Phone:404-351-6393
Practice Address - Fax:404-367-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA086261LGB207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
111185ASCAMedicare ID - Type Unspecified