Peachtree Immediate Care FP, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

18-10206 Issued in GA

Legal business name

PEACHTREE IMMEDIATE CARE FP, LLC

Practice address

1495 Lafayette Pkwy
Lagrange, GA 30241-2552

Phone

(706) 884-7822

Fax

(706) 884-7828

NPI assigned

Jul 2, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Andrea Malik-Roe

Title

Cfo

Phone

(678) 504-6392

Specialties & licenses 1

Addresses

Other names 1

• Peachtree Immediate Care Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Peachtree Immediate Care5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Mableton, GA
  • NPI 1023504180
  NPD tax ID
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Newnan, GA
  • NPI 1538655683
  NPD tax ID
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Snellville, GA
  • NPI 1649766791
  NPD tax ID
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Oakwood, GA
  • NPI 1982190039
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1316433477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W STE 201",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144538",
            "telephone_number": "678-688-9685",
            "fax_number": "770-626-3791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 LAFAYETTE PKWY",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302412552",
            "telephone_number": "706-884-7822",
            "fax_number": "706-884-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE IMMEDIATE CARE FP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "MALIK-ROE",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "678-504-6392",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "18-10206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Immediate Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pathways Center for Behavioral and Developmental Growth
• Pathways Center for Behavioral and Developmental Growth
• Patricia Ann Deloach Salter, DMD, PC
• Sarah Pauley
• Stevie Hardigree Pauley
• Peachtree Nursing & Rehabilitation LLC
• Scott Pearson, PA-C
• Pediatric Associates of Lagrange
• Beth Ann Pendergraph, P.A.
• Michelle Lynn Perdue, LPN

• All providers in Lagrange, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.