MEDICARE: JESSICA MARIE PEELER FNP-C

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	363LF0000X	Family Nurse Practitioner	RN195851	GA

General Provider Information

NPI Number	:	1164979852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE PEELER FNP-C

Provider Business Mailing Address
First Line	:	330 SANDY LAKE CIR
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4103
Country	:	US
Telephone Number	:	678-827-9267
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 N HAIRSTON RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3423
Country	:	US
Telephone Number	:	770-498-4474
Fax Number	:

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

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	02/07/2020

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