Organization
PEACE HEALTH FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN SCOTT (PRACTICE ADMINISTRATOR)
(770) 907-8400
Entity
Organization
Contact information
Practice address
653 ROBERTS DR, SUTIE A, RIVERDALE, GA 30274-2959
(770) 907-8400
(770) 907-8430
Mailing address
653 ROBERTS DR, RIVERDALE, GA 30274-2959
(770) 907-8400
(770) 907-8430
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00441955G
GEORGIA MEDICAID
GA
05
—
00441955G
—
GA
01
—
116691
PEACH STATE
GA
01
—
52264408
BLUE CROSS BLUE SHIEL OF GEORGIA
GA
Enumeration date
05/10/2007
Last updated
05/15/2008
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