MEDICARE: PEACHTREE FAMILY PSYCHIATRY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0016X	Prescribing (Medical) Psychologist	49237	GA

General Provider Information

NPI Number	:	1487059564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE FAMILY PSYCHIATRY CLINIC

Provider Business Mailing Address
First Line	:	1776 PEACHTREE ST NW
Second Line	:	SUITE 310 NORTH
City	:	ATLANTA
State	:	GA
Zip	:	30309-2307
Country	:	US
Telephone Number	:	404-249-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 PEACHTREE ST NW STE 320
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2447
Country	:	US
Telephone Number	:	404-249-8496
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. YASSAR KANAWATI
Credential	:	M.D.
Telephone Number	:	770-380-0635

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	06/26/2024

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