Organization
PEACHTREE IMMEDIATE CARE FP, LLC
Active
Other names
Peachtree Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA MALIK-ROE (CFO)
(678) 504-6392
Entity
Organization
Contact information
Practice address
1495 LAFAYETTE PKWY, LAGRANGE, GA 30241-2552
(706) 884-7822
(706) 884-7828
Mailing address
1275 HIGHWAY 54 W STE 201, FAYETTEVILLE, GA 30214-4538
(678) 688-9685
(770) 626-3791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18-10206
GA
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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