Healthcare Provider Details

I. General information

NPI: 1962185983
Provider Name (Legal Business Name): KALEY PEACOCK THRASHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N CREST BLVD
MACON GA
31210-1845
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4891
US

V. Phone/Fax

Practice location:
  • Phone: 478-841-9333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN249060
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: