Healthcare Provider Details

I. General information

NPI: 1063347987
Provider Name (Legal Business Name): PEACH SOUTH CASE MANAGEMENT AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2692 HARRIS ST STE 220
ATLANTA GA
30344-2672
US

IV. Provider business mailing address

2692 HARRIS ST STE 220
ATLANTA GA
30344-2672
US

V. Phone/Fax

Practice location:
  • Phone: 404-488-3589
  • Fax:
Mailing address:
  • Phone: 404-488-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICA AVERY
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-488-3589