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General NPI Number Information
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NPI Number | 1609254051
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Entity Type | Individual
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Provider Name | JUSTIN CLINT MCPEAK NP
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Gender | Male
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2230 TOWNE LAKE PKWY
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City | WOODSTOCK
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State | GA
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Zip | 30189-5584
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Country | US
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Telephone | 770-676-7887
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 EVES RD
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City | ROSWELL
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State | GA
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Zip | 30076-3300
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Country | US
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Telephone | 205-435-1565
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN235357
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN235357
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License Number State | GA
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