MEDICARE: PEACH SOUTH CASE MANAGEMENT AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1063347987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACH SOUTH CASE MANAGEMENT AGENCY LLC

Provider Business Mailing Address
First Line	:	2692 HARRIS ST STE 220
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2672
Country	:	US
Telephone Number	:	404-488-3589
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 HARRIS ST STE 220
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2672
Country	:	US
Telephone Number	:	404-488-3589
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERICA AVERY
Credential	:
Telephone Number	:	404-488-3589

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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