Provider Demographics
NPI:1730598491
Name:PEACH CARE LLC
Entity type:Organization
Organization Name:PEACH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABDELMALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-496-3000
Mailing Address - Street 1:3722 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-7540
Mailing Address - Country:US
Mailing Address - Phone:912-496-3000
Mailing Address - Fax:
Practice Address - Street 1:3722 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-7540
Practice Address - Country:US
Practice Address - Phone:912-496-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty