1366595068 NPI number — PEACHTREE VASCULAR SPECIALISTS, P.C.

Table of content: AMIR ARFAEI MD (NPI 1841270584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366595068 NPI number — PEACHTREE VASCULAR SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACHTREE VASCULAR SPECIALISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366595068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 SOUTHCREST DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-6118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-996-9945
Provider Business Mailing Address Fax Number:
770-996-7355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 REILLY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-6118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-1035
Provider Business Practice Location Address Fax Number:
910-907-9468
Provider Enumeration Date:
01/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDEVITT
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-996-9945

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)