Healthcare Provider Details

I. General information

NPI: 1093710196
Provider Name (Legal Business Name): ANNETTE RHODA PEPPARD AU. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MARGIE DR
WARNER ROBINS GA
31088-7817
US

IV. Provider business mailing address

302 MARGIE DR
WARNER ROBINS GA
31088-7817
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-2705
  • Fax: 478-953-2857
Mailing address:
  • Phone: 478-953-2705
  • Fax: 478-953-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD001218
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD001218
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: