PEACHTREE HEALTH GROUP LLC
NPI 1174472641
General Practice in Kennesaw, GA
About Peachtree Health Group Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PEACHTREE HEALTH GROUP LLC (NPI 1174472641), doing business as Kennesaw Primary Care, is a healthcare organization registered as a general practice in Kennesaw, Georgia and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through June 29, 2028 and lists Shishir Gupta, Member, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Peachtree Health Group Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Peachtree Health Group LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2346430
Peachtree Health Group LLC Dba Kennesaw Primary Care · Kennesaw, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Peachtree Health Group LLC's NPI number?
The NPI number for Peachtree Health Group LLC is 1174472641. It was assigned to this organization in the NPPES registry on January 27, 2026. The provider is doing business as Kennesaw Primary Care.
Where is Peachtree Health Group LLC located?
Peachtree Health Group LLC is located at 6110 Pine Mountain Rd NW Ste 201, Kennesaw, GA 30152. The listed phone number is (229) 563-3738.
What is Peachtree Health Group LLC's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Peachtree Health Group LLC enrolled in Medicare?
Yes. Peachtree Health Group LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Peachtree Health Group LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Peachtree Health Group LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Peachtree Health Group LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2346430) is associated with this NPI, valid through June 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Peachtree Health Group LLC was last updated on May 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Peachtree Health Group Llc · NPI 1174472641
General Practice organization in Kennesaw, Georgia. Organization record, active in the CMS NPPES registry since January 27, 2026.
## Identity
- **NPI:** 1174472641 (Entity type: Organization)
- **Enumerated:** January 27, 2026
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Also known as:** Kennesaw Primary Care (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Shishir Gupta, MEMBER
## Practice location
- **Address:** 6110 PINE MOUNTAIN RD NW STE 201, Kennesaw, GA 30152-3357
- **Phone:** (229) 563-3738
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 21, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1174472641) · Data from the CMS NPPES public registry.