Provider Demographics
NPI:1750088860
Name:PEACH PEDIATRIC PSYCHOLOGICAL CENTER
Entity type:Organization
Organization Name:PEACH PEDIATRIC PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLER
Authorized Official - Middle Name:TURNQUIST
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-676-2159
Mailing Address - Street 1:260 BATTEY FARM RD NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-8944
Mailing Address - Country:US
Mailing Address - Phone:706-676-2159
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW STE 601
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2450
Practice Address - Country:US
Practice Address - Phone:478-242-6763
Practice Address - Fax:404-205-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty