# MEDPEACH CONSULTING, LLC

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

## Provider details

- **NPI number:** 1558770503
- **Authorized official:** MR. VICKY ENN D.O (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (863) 232-5062

## Contact information

- **Practice address:** 931 LOWER FAYETTEVILLE RD, SUITE J, NEWNAN, GA 30263-5790
- **Practice address phone:** (770) 683-4772
- **Practice address fax:** (888) 235-9876
- **Mailing address:** 931 LOWER FAYETTEVILLE RD, SUITE J, NEWNAN, GA 30263-5790
- **Mailing address phone:** (770) 683-4772
- **Mailing address fax:** (888) 235-9876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OS8157 | GA | Yes |

## Other

- **Enumeration date:** 08/04/2014
- **Last updated:** 08/06/2014