Provider Demographics
NPI:1225806292
Name:PEACHTREE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:PEACHTREE PSYCHIATRY LLC
Other - Org Name:NITHYASRI LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-414-3333
Mailing Address - Street 1:10525 GRANDVIEW SQ
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2518
Mailing Address - Country:US
Mailing Address - Phone:334-414-3333
Mailing Address - Fax:
Practice Address - Street 1:2151 PEACHFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6534
Practice Address - Country:US
Practice Address - Phone:770-455-3200
Practice Address - Fax:770-455-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty