Provider Demographics
NPI:1891822235
Name:PEACHTREE PSYCHIATRIC PROFESSIONALS PC
Entity Type:Organization
Organization Name:PEACHTREE PSYCHIATRIC PROFESSIONALS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-351-2008
Mailing Address - Street 1:3500 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 775
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1520
Mailing Address - Country:US
Mailing Address - Phone:404-351-2008
Mailing Address - Fax:404-351-0243
Practice Address - Street 1:3500 PIEDMONT RD NE
Practice Address - Street 2:SUITE 775
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1507
Practice Address - Country:US
Practice Address - Phone:404-351-2008
Practice Address - Fax:404-351-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty