Healthcare Provider Details

I. General information

NPI: 1114965191
Provider Name (Legal Business Name): PEACHTREE PULMONARY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE SUITE 435
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

2001 PEACHTREE RD NE SUITE 435
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-1994
  • Fax: 404-352-9361
Mailing address:
  • Phone: 404-352-1994
  • Fax: 404-352-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE ALAN CASSIDY
Title or Position: DOCTOR OF MEDICINE
Credential: MD
Phone: 404-352-1994