=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588503403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRHH-ATL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1070 441 HISTORIC HWY
-----------------------------------------------------
City | DEMOREST
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30535-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-900-7378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1070 441 HISTORIC HWY
-----------------------------------------------------
City | DEMOREST
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30535-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-900-7378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | ALEXANDER MOORE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 202-213-2339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------