Healthcare Provider Details

I. General information

NPI: 1487059564
Provider Name (Legal Business Name): PEACHTREE FAMILY PSYCHIATRY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PEACHTREE ST NW STE 320
ATLANTA GA
30309-2447
US

IV. Provider business mailing address

1776 PEACHTREE ST NW SUITE 310 NORTH
ATLANTA GA
30309-2307
US

V. Phone/Fax

Practice location:
  • Phone: 404-249-8496
  • Fax:
Mailing address:
  • Phone: 404-249-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number49237
License Number StateGA

VIII. Authorized Official

Name: DR. YASSAR KANAWATI
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 770-380-0635