Provider Demographics
NPI:1063092294
Name:PEACHTREE RECOVERY SOLUTIONS
Entity type:Organization
Organization Name:PEACHTREE RECOVERY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-694-5887
Mailing Address - Street 1:3060 BUSINESS PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:404-694-5887
Mailing Address - Fax:
Practice Address - Street 1:3060 BUSINESS PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:404-694-5887
Practice Address - Fax:770-637-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA81534OtherANA LISA CARR MD
GA43028OtherMEDICAL DIRECTOR - AVRIL SHONGO MD