Basic Information
| Provider Information | |||||||||
| NPI: | 1780344093 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRH MD MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 HIGHWAY 54 W STE 201 | ||||||||
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| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786889685 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14421 BALTIMORE AVE | ||||||||
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| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207074949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2407866684 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2021 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | MALIK ROE | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6785046392 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.