Provider Demographics
NPI:1245877133
Name:CUMISKEY, PETER DYLAN
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DYLAN
Last Name:CUMISKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 WOODBOURNE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-4605
Mailing Address - Country:US
Mailing Address - Phone:954-526-5241
Mailing Address - Fax:
Practice Address - Street 1:1017 FAYETTEVILLE RD SE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2932
Practice Address - Country:US
Practice Address - Phone:404-324-4190
Practice Address - Fax:404-324-4191
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor