Provider Demographics
NPI:1457762486
Name:PEACHTREE MEDICAL CENTER
Entity Type:Organization
Organization Name:PEACHTREE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LORENA
Authorized Official - Last Name:FRIEDL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:770-487-7807
Mailing Address - Street 1:2579 HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1451
Mailing Address - Country:US
Mailing Address - Phone:770-487-7807
Mailing Address - Fax:770-487-7619
Practice Address - Street 1:2579 HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1451
Practice Address - Country:US
Practice Address - Phone:770-487-7807
Practice Address - Fax:770-487-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203757314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility