Provider Demographics
NPI:1700608353
Name:PEACHTREE FAMILY MEDICINE, LLC.
Entity type:Organization
Organization Name:PEACHTREE FAMILY MEDICINE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HOLLY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:912-415-8552
Mailing Address - Street 1:1414 OGDEN LOOP
Mailing Address - Street 2:
Mailing Address - City:ODUM
Mailing Address - State:GA
Mailing Address - Zip Code:31555
Mailing Address - Country:US
Mailing Address - Phone:912-415-8552
Mailing Address - Fax:
Practice Address - Street 1:330 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0246
Practice Address - Country:US
Practice Address - Phone:912-415-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty