MEDICARE: TABATHA PESHEL NP

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	363L00000X	Nurse Practitioner	115803	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821149139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABATHA PESHEL NP

Provider Business Mailing Address
First Line	:	60 CHASTAIN CENTER BLVD NW STE 66
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5598
Country	:	US
Telephone Number	:	770-423-0595
Fax Number	:	678-391-5055

Provider Business Practice Location Address
First Line	:	148 BILL CARRUTH PKWY
Second Line	:	SUITE 100
City	:	HIRAM
State	:	GA
Zip	:	30141-3754
Country	:	US
Telephone Number	:	678-324-4444
Fax Number	:	770-528-9932

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	09/19/2025

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Directions to “ TABATHA PESHEL NP” Practice Location

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