Healthcare Provider Details

I. General information

NPI: 1619481686
Provider Name (Legal Business Name): PEGGY HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY LEA FULMER

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 10/08/2026
Certification Date: 10/02/2026
Deactivation Date: 10/02/2018
Reactivation Date: 12/05/2018

III. Provider practice location address

UNKNOWN AT THIS TIME
SNELLVILLE GA
30078
US

IV. Provider business mailing address

2020 BUCKLEY TRL
SNELLVILLE GA
30078-3484
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-1000
  • Fax:
Mailing address:
  • Phone: 404-384-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN188890
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN188890
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN188890
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN188890
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: