Basic Information
| Provider Information | |||||||||
| NPI: | 1366181208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 HIGHWAY 54 W STE 201 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786889685 | ||||||||
| FaxNumber: | 7706263791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 HIGHWAY 54 W STE 201 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786889685 | ||||||||
| FaxNumber: | 7706263791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | LARKEE | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING LEAD | ||||||||
| AuthorizedOfficialTelephone: | 6785739446 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | 1437194156 | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.