Healthcare Provider Details

I. General information

NPI: 1891822235
Provider Name (Legal Business Name): PEACHTREE PSYCHIATRIC PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 PIEDMONT RD NE SUITE 775
ATLANTA GA
30305-1507
US

IV. Provider business mailing address

3500 PIEDMONT RD NE SUITE 775
ATLANTA GA
30305-1520
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-2008
  • Fax: 404-351-0243
Mailing address:
  • Phone: 404-351-2008
  • Fax: 404-351-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY LISA HUBER
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 404-351-2008