=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043632334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACHTREE HOSPICE OF GEORGIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1233 EAGLES LANDING PKWY STE A
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-6399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-583-2269
-----------------------------------------------------
Fax | 678-583-2270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 GEMINI CIR STE 202
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-5842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-949-0400
-----------------------------------------------------
Fax | 205-949-0405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. CHRISTOPHER SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-949-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------