PEACHTREE FAYETTE WOMEN'S SPECIALISTS (NPI# 1164475703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164475703 |
| Entity Type | Organization |
| Organization Name | PEACHTREE FAYETTE WOMEN'S SPECIALISTS |
| Practice Address |
1267 Highway 54 W Suite 3200 Fayetteville GA 30214-4526 |
| Practice Telephone | 7706329900 |
| Practice Fax Number | 7706329997 |
| Mailing Telephone | 7706329900 |
| Mailing Fax Number | 7706329997 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-10-02 |
| Authorized Official Name | MICHELE R BRANDT (R.N., PRACTICE MANAGER) |
| Authorized Official Telephone | 7706329900 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 20002063 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1267 HIGHWAY 54 W SUITE 3200 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-4526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912902107 | Charles William Pettus | Internal Medicine | 1267 Highway 54 W, Ste 2200, Fayetteville, GA 30214-2114 | 2005-06-15 |
| 1528466679 | Kelly Teed | Genetic Counselor, MS | 1267 Highway 54 W, Suite 4000, Fayetteville, GA 30214-2114 | 2014-12-05 |
| 1811398233 | Leah Keith | Nurse Practitioner | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2014-09-05 |
| 1083024095 | Hannah Katharine Shell | Nurse Practitioner | 1267 Highway 54 W, Ste 2200, Fayetteville, GA 30214-2114 | 2014-04-29 |
| 1407194558 | Georgia Urology Pa | Urology | 1267 Highway 54 W, Suite 5200, Fayetteville, GA 30214-2114 | 2013-01-24 |
| 1750679775 | Lilibird Pichardo | Obstetrics & Gynecology | 1267 Highway 54 W, Suite 3200, Fayetteville, GA 30214-2114 | 2011-07-11 |
| 1598080129 | David G Tian | Internal Medicine | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2010-04-07 |
| 1871720003 | Joseph Lavallo | Nurse Practitioner | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2009-06-15 |
| 1477714517 | Ryan K. Crisel | Internal Medicine | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2110 | 2008-06-20 |
| 1740447820 | David Jaehan Yoo | Internal Medicine | 1267 Highway 54 W, Suite 5400, Fayetteville, GA 30214-2114 | 2008-05-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811398852 | Fayetteville Woman's Care | Obstetrics & Gynecology | 2029 Valley Gate Drive, Suite 101, Fayetteville, NC 28304-3772 | 2014-09-09 |
| 1194126250 | A Woman Place In Fayetteville LLC | Obstetrics & Gynecology | 2053 Valley Gate Drive, Suite 201, Fayetteville, NC 28304-3983 | 2014-09-09 |
| 1336568153 | Melvin Henderson | Obstetrics & Gynecology | 413 Owen Dr Ste 101, Fayetteville, NC 28304-3490 | 2014-04-09 |
| 1932464617 | Nicole E Quinn | Obstetrics & Gynecology | 1267 Highway 54 W Ste 3200, Fayetteville, GA 30214-2111 | 2012-07-10 |
| 1093945115 | Lydia B Apollo | Obstetrics & Gynecology | 2053 Valleygate Dr Ste 201, Fayetteville, NC 28304-3983 | 2009-07-23 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1780889766 | Amy L Scott | Obstetrics & Gynecology | 3215 N Northhills Blvd Ste B, Fayetteville, AR 72703-4424 | 2007-06-19 |
| 1790844256 | Christine Dennett Booth | Obstetrics & Gynecology | 1341 Walter Reed Rd, Fayetteville, NC 28304-4415 | 2006-12-08 |
| 1316033368 | Camille Jamil Wehbe | Obstetrics & Gynecology | 3609 Cape Center Dr, Fayetteville, NC 28304-4457 | 2006-10-05 |
| 1154345346 | Dorrette P Grant | Obstetrics & Gynecology | 2573 Ravenhill Dr, Fayetteville, NC 28303-5451 | 2006-07-27 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.