Provider Demographics
NPI:1245962778
Name:PEACHTREE WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:PEACHTREE WELLNESS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-497-1982
Mailing Address - Street 1:116 PEACHTREE CT STE B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4800
Mailing Address - Country:US
Mailing Address - Phone:513-497-1982
Mailing Address - Fax:
Practice Address - Street 1:100 GOVERNORS TRCE STE 110
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4853
Practice Address - Country:US
Practice Address - Phone:513-497-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA70170OtherDR. BRYON MCQUIRT