Healthcare Provider Details

I. General information

NPI: 1821792128
Provider Name (Legal Business Name): NOREEN O'CONNOR PEYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 KANAWHA CT
STONE MOUNTAIN GA
30087-2108
US

IV. Provider business mailing address

1455 MONTREAL RD. E
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 478-501-6778
  • Fax:
Mailing address:
  • Phone: 404-251-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number121490
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number121490
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: