Provider Demographics
NPI:1235573841
Name:PEACHTREE IMMEDIATE CARE UC, LLC
Entity type:Organization
Organization Name:PEACHTREE IMMEDIATE CARE UC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF BILLING OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SHANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-679-6471
Mailing Address - Street 1:1834 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3405
Mailing Address - Country:US
Mailing Address - Phone:404-634-4443
Mailing Address - Fax:404-634-4414
Practice Address - Street 1:1834 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3405
Practice Address - Country:US
Practice Address - Phone:404-634-4443
Practice Address - Fax:404-634-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care