Provider Demographics
NPI:1609536911
Name:CRH MD MANAGEMENT LLC
Entity Type:Organization
Organization Name:CRH MD MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALIK ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-504-6392
Mailing Address - Street 1:1275 HIGHWAY 54 W STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4538
Mailing Address - Country:US
Mailing Address - Phone:678-688-9685
Mailing Address - Fax:
Practice Address - Street 1:750 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1133
Practice Address - Country:US
Practice Address - Phone:301-424-0658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care