Provider Demographics
NPI:1184489445
Name:KISSELL, PETER ZACHARY (MED, MS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ZACHARY
Last Name:KISSELL
Suffix:
Gender:M
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 N POINT PKWY STE 75
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1146
Mailing Address - Country:US
Mailing Address - Phone:770-645-8933
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 75
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1146
Practice Address - Country:US
Practice Address - Phone:770-645-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health