Provider Demographics
NPI:1013296078
Name:PEACHTREE SPINE CENTER
Entity type:Organization
Organization Name:PEACHTREE SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-876-6964
Mailing Address - Street 1:1401 PEACHTREE ST NE STE 160
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3000
Mailing Address - Country:US
Mailing Address - Phone:404-475-0386
Mailing Address - Fax:404-475-0443
Practice Address - Street 1:1401 PEACHTREE ST NE STE 160
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3000
Practice Address - Country:US
Practice Address - Phone:404-475-0386
Practice Address - Fax:404-475-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005228305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization