Healthcare Provider Details

I. General information

NPI: 1871623314
Provider Name (Legal Business Name): PEGGY DIANE CHESTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 EAGER DR
ALBANY GA
31707-3862
US

IV. Provider business mailing address

1306 EAGER DR
ALBANY GA
31707-3862
US

V. Phone/Fax

Practice location:
  • Phone: 229-434-1372
  • Fax: 229-434-0382
Mailing address:
  • Phone: 229-434-1372
  • Fax: 229-434-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: