# PIEDMONT MEDICAL CARE CORPORATION

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

## Provider details

- **NPI number:** 1912211129
- **Authorized official:** CHRISTY AQUINO (DIRECTOR, PROVIDER ENROLLMENT)
- **Authorized official phone:** (470) 895-0214

## Contact information

- **Practice address:** 4000 SHAKERAG HL, SUITE 301, PEACHTREE CITY, GA 30269-4047
- **Practice address phone:** (770) 486-7192
- **Practice address fax:** (770) 486-7110
- **Mailing address:** PO BOX 102321, ATLANTA, GA 30368-2321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | RN115077 | GA | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 04/11/2023