Provider Demographics
NPI:1366595068
Name:PEACHTREE VASCULAR SPECIALISTS, P.C.
Entity type:Organization
Organization Name:PEACHTREE VASCULAR SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-9945
Mailing Address - Street 1:1035 SOUTHCREST DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6118
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:770-996-7355
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-6118
Practice Address - Country:US
Practice Address - Phone:910-907-1035
Practice Address - Fax:910-907-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP113Medicare ID - Type Unspecified