Healthcare Provider Details

I. General information

NPI: 1356062236
Provider Name (Legal Business Name): SHARON DENISE PEEBLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE PEEBLES FNP

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125B VICTORY DR
SWAINSBORO GA
30401-3234
US

IV. Provider business mailing address

125B VICTORY DR
SWAINSBORO GA
30401-3234
US

V. Phone/Fax

Practice location:
  • Phone: 478-419-1250
  • Fax: 478-419-1252
Mailing address:
  • Phone: 478-419-1250
  • Fax: 478-419-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN150025
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: