# PEACHTREE HEALTH GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kennesaw Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174472641
- **Authorized official:** SHISHIR GUPTA MD (MEMBER)
- **Authorized official phone:** (229) 563-3738

## Contact information

- **Practice address:** 6110 PINE MOUNTAIN RD NW STE 201, KENNESAW, GA 30152-3357
- **Practice address phone:** (229) 563-3738
- **Mailing address:** 6110 PINE MOUNTAIN RD NW STE 201, KENNESAW, GA 30152-3357
- **Mailing address phone:** (229) 563-2094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2026
- **Last updated:** 05/21/2026