Organization
PEACHTREE IMMEDIATE CARE FP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANDI FAULK (VICE PRESIDENT, BILLING OPERATIONS)
(678) 679-6471
Entity
Organization
Contact information
Practice address
3827 JIMMY LEE SMITH PKWY, HIRAM, GA 30141-2630
(770) 222-8900
(770) 222-2757
Mailing address
590 LANIER AVE W, FAYETTEVILLE, GA 30214-1504
(678) 688-9685
(770) 626-3791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003137060A
—
GA
Enumeration date
06/17/2006
Last updated
09/24/2025
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