Healthcare Provider Details

I. General information

NPI: 1588503403
Provider Name (Legal Business Name): CRHH-ATL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 441 HISTORIC HWY
DEMOREST GA
30535-4144
US

IV. Provider business mailing address

1070 441 HISTORIC HWY
DEMOREST GA
30535-4144
US

V. Phone/Fax

Practice location:
  • Phone: 404-900-7378
  • Fax:
Mailing address:
  • Phone: 404-900-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER MOORE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 202-213-2339