Medpeach Consulting, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS8157 Issued in GA

Legal business name

MEDPEACH CONSULTING, LLC

Practice address

931 Lower Fayetteville Rd
Suite J
Newnan, GA 30263-5790

Phone

(770) 683-4772

Fax

(888) 235-9876

NPI assigned

Aug 4, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Vicky Enn, D.O

Title

Credentialing Specialist

Phone

(863) 232-5062

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1558770503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 LOWER FAYETTEVILLE RD",
            "address_2": "SUITE J",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302635790",
            "telephone_number": "770-683-4772",
            "fax_number": "888-235-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 LOWER FAYETTEVILLE RD",
            "address_2": "SUITE J",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302635790",
            "telephone_number": "770-683-4772",
            "fax_number": "888-235-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPEACH CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-04",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "ENN",
        "authorized_official_first_name": "VICKY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "863-232-5062",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "OS8157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "893020594A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Newnan, GA
• Providers in Newnan, 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 Aug 6, 2014; 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.