Healthcare Provider Details

I. General information

NPI: 1902641749
Provider Name (Legal Business Name): PEACHTREE CHRISTIAN HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 PREMIERE PKWY STE 400
DULUTH GA
30097-8915
US

IV. Provider business mailing address

3090 PREMIERE PKWY STE 400
DULUTH GA
30097-8915
US

V. Phone/Fax

Practice location:
  • Phone: 770-624-2727
  • Fax:
Mailing address:
  • Phone: 770-624-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNE M MANCINI
Title or Position: CEO
Credential:
Phone: 770-624-2727