Organization · NPI-2
Peachtree Immediate Care Fp, LLC
Family Medicine · Mableton, GA
NPI number1023504180
StatusActive
Last updated in NPPESJul 2, 2018
Details
- NPI
- 1023504180
- Entity type
- Organization (NPI-2)
- Legal business name
- Peachtree Immediate Care Fp, LLC
- Organization subpart
- No
- Enumeration date
- Jul 2, 2018
- Last updated
- Jul 2, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | OCC010814 | GA | Yes |
Other names
- Peachtree Immediate Care (Doing Business As)
Practice location
1025 Veterans Memorial HwySuite 720
Mableton, GA 30126-7239
Phone 770-732-0720 · Fax 770-732-0730
Mailing address
1275 Highway 54 W Ste 201Fayetteville, GA 30214-4538
Phone 678-688-9685 · Fax 770-626-3791
Authorized official
Andrea Malik-Roe
Cfo
6785046392
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