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General NPI Number Information
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NPI Number | 1063347987
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Entity Type | Organization
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Legal Business Name | PEACH SOUTH CASE MANAGEMENT AGENCY LLC
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Dates
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Enumeration Date | 06/13/2026
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Last Update Date | 06/13/2026
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Provider Practice Location Address
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Address Line | 2692 HARRIS ST STE 220
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City | ATLANTA
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State | GA
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Zip | 30344-2672
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Country | US
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Telephone | 404-488-3589
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Fax |
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Provider Business Mailing Address
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Address Line | 2692 HARRIS ST STE 220
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City | ATLANTA
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State | GA
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Zip | 30344-2672
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Country | US
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Telephone | 404-488-3589
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERICA AVERY
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Credential |
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Telephone | 404-488-3589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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