Healthcare Provider Details

I. General information

NPI: 1336323344
Provider Name (Legal Business Name): PEGGY MAXINE SCHROEDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

5065 TRIMBLE RD NE
ATLANTA GA
30342-2422
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2008
  • Fax: 404-785-4496
Mailing address:
  • Phone: 404-354-2678
  • Fax: 404-303-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN10069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: