Provider Demographics
NPI:1255788436
Name:PEACHTREE HOSPICE OF GEORGIA, LLC
Entity type:Organization
Organization Name:PEACHTREE HOSPICE OF GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-932-6302
Mailing Address - Street 1:1395 S MARIETTA PKWY SE
Mailing Address - Street 2:BLDG 400 SUITE 116
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:678-932-6302
Mailing Address - Fax:678-402-5246
Practice Address - Street 1:354 CORPORATE CENTER CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6360
Practice Address - Country:US
Practice Address - Phone:678-583-2269
Practice Address - Fax:678-583-2270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACHTREE HOSPICE OF GEORGIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty