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General NPI Number Information
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NPI Number | 1942623012
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Entity Type | Individual
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Provider Name | HEATHER PEAK RN
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Gender | Female
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 175 GWINNETT DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5671
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Country | US
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Telephone | 770-241-5235
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Fax | 678-682-8747
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Provider Business Mailing Address
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Address Line | 175 GWINNETT DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5671
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Country | US
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Telephone | 770-241-5235
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Fax | 678-682-8747
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN119363
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN119363
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN119363
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN119363
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RN119363
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License Number State | GA
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