Provider Demographics
NPI:1679398135
Name:CRH MD MANAGEMENT, LLC
Entity type:Organization
Organization Name:CRH MD MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-679-6471
Mailing Address - Street 1:590 LANIER AVE W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1504
Mailing Address - Country:US
Mailing Address - Phone:678-688-9685
Mailing Address - Fax:
Practice Address - Street 1:45325 ABELL HOUSE LN
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3211
Practice Address - Country:US
Practice Address - Phone:301-862-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care