Provider Demographics
NPI:1043619141
Name:PEACHTREE HOME HEALTH, LLC
Entity type:Organization
Organization Name:PEACHTREE HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDIN-MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-365-4424
Mailing Address - Street 1:1101 KERMIT DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5102
Mailing Address - Country:US
Mailing Address - Phone:615-365-4424
Mailing Address - Fax:615-365-7897
Practice Address - Street 1:2135 EASTVIEW PKWY STE 800
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5772
Practice Address - Country:US
Practice Address - Phone:678-806-5336
Practice Address - Fax:678-806-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122 - 195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117111Medicare Oscar/Certification