=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225806292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACHTREE PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2023
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 PEACHFORD RD
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-6534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-455-3200
-----------------------------------------------------
Fax | 770-455-3200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10525 GRANDVIEW SQ
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-2518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-414-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAMKANTH VEMULURI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 334-414-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------