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General NPI Number Information
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NPI Number | 1407743404
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Entity Type | Organization
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Legal Business Name | PEACEFUL POND PSYCHIATRY
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 12/25/2025
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Provider Practice Location Address
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Address Line | 288 N CLAYTON ST STE 1
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4815
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Country | US
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Telephone | 678-404-6043
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Fax | 855-600-5833
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Provider Business Mailing Address
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Address Line | 685 PAPER CREEK DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5328
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Country | US
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Telephone | 678-907-7329
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | KIMBERLY ABUAJAH
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Credential | NP
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Telephone | 678-404-6043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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