Healthcare Provider Details

I. General information

NPI: 1992643860
Provider Name (Legal Business Name): JESSE LEE PEEPLES III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 NORTHLAKE CREEK DR
TUCKER GA
30084-3426
US

IV. Provider business mailing address

3786 NORTHLAKE CREEK DR
TUCKER GA
30084-3426
US

V. Phone/Fax

Practice location:
  • Phone: 678-591-0198
  • Fax:
Mailing address:
  • Phone: 678-591-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: