| NPI | 1235721879 |
|---|---|
| Doing Business As | PEACHTREE MEDICAL CLINIC |
| Doing Business As | PEACHTREE MEDICAL CARE, LLC |
| Entity Type | Organization |
| Authorized Contact | LORENA CANNON Owner / Provider 208-351-5458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-03-08 |