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General NPI Number Information
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NPI Number | 1255428793
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Entity Type | Individual
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Provider Name | PEGGY FOGG CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 48 MEDICAL PARK DR E STE 355
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3470
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Country | US
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Telephone | 205-838-3036
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Fax | 205-838-5832
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Provider Business Mailing Address
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Address Line | 750 PETER BRYCE BLVD
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City | TUSCALOOSA
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State | AL
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Zip | 35401-7456
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Country | US
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Telephone | 205-348-6262
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Fax | 205-348-4121
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 041333443
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209004753
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0371998
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License Number State | AL
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