Provider Demographics
NPI:1851918999
Name:PEACH SEED HEALTHCARE
Entity Type:Organization
Organization Name:PEACH SEED HEALTHCARE
Other - Org Name:MBH HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-531-2580
Mailing Address - Street 1:3455 PEACHTREE RD NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3236
Mailing Address - Country:US
Mailing Address - Phone:470-531-2580
Mailing Address - Fax:470-531-2580
Practice Address - Street 1:1635 OLD 41 HWY NW STE 141
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4480
Practice Address - Country:US
Practice Address - Phone:678-400-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty