Provider Demographics
NPI:1770260432
Name:PEACHTREE DIAGNOSTICS PLLC
Entity type:Organization
Organization Name:PEACHTREE DIAGNOSTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-708-7018
Mailing Address - Street 1:42 COUNTY ROAD 4164
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-4123
Mailing Address - Country:US
Mailing Address - Phone:903-708-7018
Mailing Address - Fax:
Practice Address - Street 1:42 COUNTY ROAD 4164
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-4123
Practice Address - Country:US
Practice Address - Phone:903-708-7018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological Laboratory
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier