Healthcare Provider Details

I. General information

NPI: 1619637923
Provider Name (Legal Business Name): CRH MD MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19825 FREDERICK RD
GERMANTOWN MD
20876-1309
US

IV. Provider business mailing address

1275 HIGHWAY 54 W STE 201
FAYETTEVILLE GA
30214-4538
US

V. Phone/Fax

Practice location:
  • Phone: 240-801-9944
  • Fax:
Mailing address:
  • Phone: 678-688-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA LYNN MALIK ROE
Title or Position: PRESIDENT
Credential:
Phone: 678-504-6392