Healthcare Provider Details

I. General information

NPI: 1114474673
Provider Name (Legal Business Name): TRENT JOSEPH PEACHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GA HIGHWAY 27 E
AMERICUS GA
31709-3800
US

IV. Provider business mailing address

103 GA HIGHWAY 27 E
AMERICUS GA
31709-3800
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-8082
  • Fax:
Mailing address:
  • Phone: 229-924-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 222478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: