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Organization

MEDPEACH CONSULTING, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. VICKY ENN D.O (CREDENTIALING SPECIALIST)
(863) 232-5062
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS8157
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
893020594A
GA
Enumeration date
08/04/2014
Last updated
08/06/2014
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