NPIMap

Organization Active NPI

Peachtree Orthopaedic Clinic, P.a.

Doing business as Peachtree Orthopaedic Physical Therapy

  • Physical Therapist
  • College Park, GA
National Provider Identifier
1497781942
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PEACHTREE ORTHOPAEDIC CLINIC, P.A.
Doing business as
Peachtree Orthopaedic Physical Therapy
Practice address
1901 Phoenix Blvd
Suite 120
College Park, GA 30349-5588
Phone
(404) 355-6548
Fax
(770) 996-7299
NPI assigned
Jun 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Greg Cooper
Title
Managing Partner
Phone
(219) 365-6560

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

1901 Phoenix Blvd
Suite 120
College Park, GA 30349-5588

Mailing address

1901 Phoenix Blvd
Suite 120
College Park, GA 30349-5588
Phone (404) 355-6548

Other names 1

  • Peachtree Orthopaedic Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000751 GA Part B Supplier - Clinic/Group Practice 4587552963 Receives reassigned benefits from 145 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alpharetta, GA; Woodstock, GA; Marietta, GA; Duluth, GA; Dawsonville, GA; Cumming, GA; College Park, GA; Atlanta, GA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1497781942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 PHOENIX BLVD",
            "address_2": "SUITE 120",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495588",
            "telephone_number": "404-355-6548",
            "fax_number": "770-996-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 PHOENIX BLVD",
            "address_2": "SUITE 120",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495588",
            "telephone_number": "404-355-6548",
            "fax_number": "770-996-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE ORTHOPAEDIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "219-365-6560"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Orthopaedic Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in College Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.