Peach State Health Plan, Inc

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

12315 Issued in GA

Legal business name

PEACH STATE HEALTH PLAN, INC

Practice address

3200 Highlands Pkwy SE
Suite 300
Smyrna, GA 30082-5166

Phone

(678) 556-2300

Fax

(770) 803-0043

NPI assigned

Mar 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Herbert Spencer, M.A.

Title

Compliance Officer

Phone

(678) 556-2461

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013034552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 HIGHLANDS PKWY SE",
            "address_2": "SUITE 300",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300825166",
            "telephone_number": "678-556-2300",
            "fax_number": "770-803-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 HIGHLANDS PKWY SE",
            "address_2": "SUITE 300",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300825166",
            "telephone_number": "678-556-2300",
            "fax_number": "770-803-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE HEALTH PLAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "678-556-2461",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "GA",
            "license": "12315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Alexander Patrick, DDS
• Jazmine Patton, APC, NCC, CCMHC
• Claire Donehower Paul, PHD, BCBA-D
• Gerson Paull, MD
• Peach Fit Physical Therapy & Wellness Center
• Peach State Pediatrics
• Peachtree Pharmacy & Medical Supply, Inc.
• Pedi-Eve, Inc.
• Pediatric Dentistry at Vinings
• Pediatric Development Center of Atlanta, LLC

• Health Maintenance Organization in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Health Maintenance Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.