# PEACHTREE FAMILY MEDICINE PC

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

## Provider details

- **NPI number:** 1679608582
- **Authorized official:** VERA B CARLSON MD (MD)
- **Authorized official phone:** (435) 752-5553

## Contact information

- **Practice address:** 565 W 465 N STE 130, PROVIDENCE, UT 84332-4802
- **Practice address phone:** (435) 752-5553
- **Practice address fax:** (435) 755-5043
- **Mailing address:** 169 N GATEWAY DR, 170, PROVIDENCE, UT 84332-9855
- **Mailing address phone:** (435) 752-5553
- **Mailing address fax:** (435) 755-5043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 5916429-1205 | UT | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 11/06/2024