NPIMap

Organization Active NPI

Peachtree Orthopaedic Clinic

  • Durable Medical Equipment & Medical Supplies
  • Alpharetta, GA
National Provider Identifier
1588802474
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PEACHTREE ORTHOPAEDIC CLINIC
Practice address
11800 Amber Park Dr.
Parkway 400 Building One Suite 200
Alpharetta, GA 30009
Phone
(404) 355-0743
Fax
(404) 355-2136
NPI assigned
Jan 30, 2009
Last updated
Dec 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

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

Authorized official

Name
Ed Mitchell, CPA
Title
Cfo
Phone
(404) 355-0743

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

11800 Amber Park Dr.
Parkway 400 Building One Suite 200
Alpharetta, GA 30009

Mailing address

2001 Peachtree Rd NE Ste 705
Atlanta, GA 30309-1476
Phone (404) 355-0743

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
Tax ID family
Peachtree Orthopaedic C17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

11800 Amber Park Dr
Ste 200
Alpharetta, GA 30009

5505 Peachtree Dunwoody Rd
Ste 100
Sandy Springs, GA 30342
Phone (404) 847-0893

101 Smoke Hill Ln
Ste 120
Woodstock, GA 30188
Phone (404) 355-8066

Practitioners & affiliated clinicians

Practitioners 144

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 144

NPI Registry JSON

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544659200000",
    "number": "1588802474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 PEACHTREE RD NE STE 705",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091476",
            "telephone_number": "404-355-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 AMBER PARK DR.",
            "address_2": "PARKWAY 400 BUILDING ONE SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30009",
            "telephone_number": "404-355-0743",
            "fax_number": "404-355-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE ORTHOPAEDIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2018-12-13",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "404-355-0743",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.