Organization
PEACOCK MEDICAL EQUIPMENT AND HOME HEALTH CARE LLC
Active
Other names
Peachtree Medical of Tennessee
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADAM DOUGLAS WELLINGTON PH.D (CEO/PRESIDENT)
(423) 547-3224
Entity
Organization
Contact information
Practice address
1201 HIGHWAY 19 E BYPASS SUITE 3, ELIZABETHTON, TN 37643
(423) 547-3224
(180) 041-9156
Mailing address
1201 HIGHWAY 19 E BYPASS SUITE 3, ELIZABETHTON, TN 37643
(423) 547-3224
(180) 041-9156
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000001020
TN BOARD FOR LICENSING HEALTHCARE FACILITIES DEPT OF HEALTH
TN
05
—
1144456047
—
VA
05
—
1514122
—
TN
05
—
DM1334
—
SC
Enumeration date
06/05/2009
Last updated
08/04/2010
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