Provider Demographics
NPI:1245451509
Name:PEACHTREE MEDICAL AND SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:PEACHTREE MEDICAL AND SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:770-487-3272
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-0530
Mailing Address - Country:US
Mailing Address - Phone:770-487-3272
Mailing Address - Fax:770-632-7867
Practice Address - Street 1:64 EASTBROOK BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-487-3272
Practice Address - Fax:770-632-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024876208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA45631OtherUHC
GA52672999OtherBCBS FED PRG
GA110139118OtherOTHER
GA1290417OtherUHC
GA52446409OtherBCBS OF GA
GA52446409 02OtherBCBS
GAGRP191OtherMEDICARE GRP
GA1290417OtherUHC
GA=========OtherCIGNA
GAD41305Medicare UPIN
GA=========OtherCIGNA