MEDICARE: PEGGY GRIFFITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	008825	GA

General Provider Information

NPI Number	:	1033579172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY GRIFFITH

Provider Business Mailing Address
First Line	:	2487 OOSTANAULA DR NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3521
Country	:	US
Telephone Number	:	404-550-7540
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 GLENRIDGE DR
Second Line	:	SUITE 130
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-5512
Country	:	US
Telephone Number	:	404-550-7540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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