Healthcare Provider Details

I. General information

NPI: 1992868855
Provider Name (Legal Business Name): PERISSEIA PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 LEBANON RD STE A
LAWRENCEVILLE GA
30043-5128
US

IV. Provider business mailing address

1655 LEBANON RD STE A
LAWRENCEVILLE GA
30043-5128
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-2024
  • Fax: 770-682-2034
Mailing address:
  • Phone: 770-682-2024
  • Fax: 770-682-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number029703
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number029703
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID W. KUNZ
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 770-682-2024