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General NPI Number Information
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NPI Number | 1992663462
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Entity Type | Organization
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Legal Business Name | CRH PEACHTREE PRIMARY CARE, LLC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE
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City | DECATUR
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State | GA
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Zip | 30030-2400
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Country | US
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Telephone | 678-679-6471
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W PONCE DE LEON AVE
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City | DECATUR
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State | GA
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Zip | 30030-2400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CO-FOUNDER
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Name | ANDREA MALIK ROE
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Credential |
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Telephone | 678-504-6392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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