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General NPI Number Information
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NPI Number | 1821149139
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Entity Type | Individual
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Provider Name | TABATHA PESHEL NP
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 148 BILL CARRUTH PKWY SUITE 100
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City | HIRAM
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State | GA
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Zip | 30141-3754
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Country | US
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Telephone | 678-324-4444
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Fax | 770-528-9932
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Provider Business Mailing Address
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Address Line | 60 CHASTAIN CENTER BLVD NW STE 66
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City | KENNESAW
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State | GA
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Zip | 30144-5598
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Country | US
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Telephone | 770-423-0595
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Fax | 678-391-5055
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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 | 115803
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License Number State | GA
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