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General NPI Number Information
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NPI Number | 1861998585
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Entity Type | Organization
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Legal Business Name | PEACHTREE PEDIATRIC PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 750 HAMMOND DRIVE BLDG 7, STE 200
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 404-796-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 750 HAMMOND DRIVE BLDG 7, STE 200
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 404-796-7777
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. AVITAL K COHEN
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Credential | PSY.D.
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Telephone | 404-796-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 3672
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License Number State | GA
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