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General NPI Number Information
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NPI Number | 1134040058
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Entity Type | Organization
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Legal Business Name | PEACHTREE PSYCHIATRY OF ATLANTA INC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 3330 CUMBERLAND BLVD SE STE OFFICE80
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City | ATLANTA
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State | GA
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Zip | 30339-5995
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Country | US
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Telephone | 678-253-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 CUMBERLAND BLVD SE STE OFFICE80
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City | ATLANTA
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State | GA
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Zip | 30339-5995
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Country | US
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Telephone | 678-253-0558
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Fax |
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | EBONY RENAE PETIT
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Credential | MD
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Telephone | 205-200-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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