MEDICARE: CRH MD MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1932869245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRH MD MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	590 LANIER AVE W
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-1504
Country	:	US
Telephone Number	:	678-688-9685
Fax Number	:	770-626-3791

Provider Business Practice Location Address
First Line	:	821 PRINCE FREDERICK BLVD
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3137
Country	:	US
Telephone Number	:	410-535-8911
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREA LYNN MALIK ROE
Credential	:
Telephone Number	:	678-504-6392

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	05/26/2026

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