Provider Demographics
NPI:1053453449
Name:PEAKE, ALLISON (AA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PEAKE
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:DAMPIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4280 N VALDOSTA RD
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6814
Mailing Address - Country:US
Mailing Address - Phone:229-671-2066
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:4280 N VALDOSTA RD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-671-2066
Practice Address - Fax:336-553-3994
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004923367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA477928396BMedicaid
GA511I320095Medicare PIN