# PEACHTREE PRIMARY CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437428331
- **Authorized official:** DR. ANILA H QIDWAI MD (OWNER)
- **Authorized official phone:** (770) 676-6838

## Contact information

- **Practice address:** 1570 OLD ALABAMA RD, ROSWELL, GA 30076-2107
- **Practice address phone:** (770) 676-6838
- **Practice address fax:** (770) 676-6840
- **Mailing address:** 1570 OLD ALABAMA RD, SUITE 105, ROSWELL, GA 30076-2107
- **Mailing address phone:** (770) 676-6838
- **Mailing address fax:** (770) 676-6840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 065787 | GA | Yes |

## Other

- **Enumeration date:** 12/21/2011
- **Last updated:** 05/04/2012