Provider Demographics
NPI:1447901863
Name:PEACH DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:PEACH DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAQAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-676-2200
Mailing Address - Street 1:600 BONAVENTURE AVE NE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4310
Mailing Address - Country:US
Mailing Address - Phone:770-676-2200
Mailing Address - Fax:
Practice Address - Street 1:335 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 2210
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3721
Practice Address - Country:US
Practice Address - Phone:770-676-2200
Practice Address - Fax:770-676-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty