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NPI Code Detail

MEDICARE: PEGGY S BALTIMORE LCSW

MEDICARE:   PEGGY S BALTIMORE  LCSW
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
11041C0700XClinical Social WorkerLCSW# 1089GA

General Provider Information

NPI Number : 1063421220
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY S BALTIMORE LCSW
Provider Business Mailing Address
First Line : 2901 UNIVERSITY AVE
Second Line : SUITE 38
City : COLUMBUS
State : GA
Zip : 31907-7606
Country : US
Telephone Number : 706-565-0555
Fax Number : 706-565-0556
Provider Business Practice Location Address
First Line : 2901 UNIVERSITY AVE
Second Line : SUITE 38
City : COLUMBUS
State : GA
Zip : 31907-7606
Country : US
Telephone Number : 706-565-0555
Fax Number : 706-565-0556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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Directions to “ PEGGY S BALTIMORE LCSW” Practice Location

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