Organization
PEACHTREE SURGICAL SPECIALISTS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE R HIXON (OWNER)
(404) 265-3333
Entity
Organization
Contact information
Practice address
285 BOULEVARD NE STE 440, ATLANTA, GA 30312-4213
(404) 265-3333
(404) 265-3334
Mailing address
285 BOULEVARD NE STE 440, ATLANTA, GA 30312-4213
(404) 265-3333
(404) 265-3334
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
037233
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00565012B
—
GA
01
—
1447286893
BLUE CROSS BLUE SHIELD GA
GA
Enumeration date
02/05/2008
Last updated
02/05/2008
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