Peachtree Omfs LLC, DBN Peachtree Oral & Facial Surgery

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

PEACHTREE OMFS LLC, DBN PEACHTREE ORAL & FACIAL SURGERY

Practice address

262 S Peachtree Pkwy Ste 1
Peachtree City, GA 30269-1752

Phone

(770) 302-0101

Fax

(770) 302-0105

NPI assigned

Sep 22, 2023

Organization subpart

No

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

Authorized official

Name

Lisa Newell

Title

Insurance & Billing Specialist

Phone

(770) 302-0101

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Edward Anderson Jr., MD, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Peachtree City, GA
  • NPI 1801993605
  NPD (past)
• Damian Richard Jimenez

  • Oral and Maxillofacial Surgery (Dentist)
  • Norcross, GA
  • NPI 1699919126
  NPD (past)

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1598544306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 S PEACHTREE PKWY STE 1",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691752",
            "telephone_number": "770-302-0101",
            "fax_number": "770-302-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 S PEACHTREE PKWY STE 1",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691752",
            "telephone_number": "770-302-0101",
            "fax_number": "770-302-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE OMFS LLC, DBN PEACHTREE ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-22",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "NEWELL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "INSURANCE & BILLING SPECIALIST",
        "authorized_official_telephone_number": "770-302-0101"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peachtree Infusion, LLC
• Peachtree Medical and Surgical Associates PC
• Peachtree Medical Center
• Peachtree Medical Center
• Peachtree Medical Supply LLC
• Peachtree Pediatric Dentistry
• Peachtree Pediatrics PC
• Peachtree Periodontics & Dental Implants
• Peachtree Psychotherapy
• Peachtree Senior Care LLC

• Oral & Maxillofacial Surgery (D.M.D.) in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; 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.