Healthcare Provider Details

I. General information

NPI: 1134040058
Provider Name (Legal Business Name): PEACHTREE PSYCHIATRY OF ATLANTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CUMBERLAND BLVD SE STE OFFICE80
ATLANTA GA
30339-5995
US

IV. Provider business mailing address

3330 CUMBERLAND BLVD SE STE OFFICE80
ATLANTA GA
30339-5995
US

V. Phone/Fax

Practice location:
  • Phone: 678-253-0558
  • Fax:
Mailing address:
  • Phone: 678-253-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: EBONY RENAE PETIT
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 205-200-5110