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General NPI Number Information
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NPI Number | 1124914486
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Entity Type | Individual
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Provider Name | CORREGGIO LADON PEAGLER JR.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2025
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 2300 I ST NW
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City | WASHINGTON
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State | DC
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Zip | 20052-0011
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Country | US
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Telephone | 678-920-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 3457 LIONSGATE CT
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City | LITHONIA
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State | GA
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Zip | 30038-3479
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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