Peachstate Family Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

061537 Issued in GA

Legal business name

PEACHSTATE FAMILY CLINIC, LLC

Practice address

4319 Lawrenceville Hwy NW
Lilburn, GA 30047-3416

Phone

(678) 583-8888

NPI assigned

Nov 17, 2017

Last updated

Nov 17, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Changchun Wu, MDNPI 1265642821

Title

Physician

Phone

(678) 583-8888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Changchun C Wu, MD

  • Family Medicine Physician
  • Lilburn, GA
  • NPI 1265642821
  Medicare reassignment NPD Authorized official
• Michelle Forrester, P.A.

  • Medical Physician Assistant
  • Lawrenceville, GA
  • NPI 1205140613
  Medicare reassignment
• Kathie Brand, M.D.

  • Internal Medicine Physician
  • Hicksville, NY
  • NPI 1255433744
  NPD

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1346754041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4319 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473416",
            "telephone_number": "678-583-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4319 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473416",
            "telephone_number": "678-583-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHSTATE FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "CHANGCHUN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "678-583-8888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "061537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rajesh Motibhai Patel, MD
• Shital Patel, REGISTERED NURSE
• Kimberly Taylor Patrick
• Paula M Nelson MD (Family Dermatology)
• Carla Payton
• Peachtree Spine & Pain Physicians, Inc (Peachtree Spine Physicians, Inc)
• Reginald Demetrius Peek, MD
• Pelican Hill Medical Center, LLC
• Sarah Penna, LCSW
• Madison Brooke Perkins

• Family Medicine Physician in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.