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Organization
PEACH STATE PROVIDERS GROUP INC
Active
Organization
PEACH STATE PROVIDERS GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA R TALLEY RPT (PHYSICAL THERAPIST)
(770) 960-9979
Entity
Organization
Contact information
Practice address
7146 SOUTHLAKE PARKWAY, MORROW, GA 30260
(770) 960-9979
(770) 960-9662
Mailing address
146 HAWN ROAD, FAYETTEVILLE, GA 30215
(770) 460-1494
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1741
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00881218A
—
GA
Enumeration date
02/15/2007
Last updated
08/22/2020
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