Provider Demographics
NPI:1073641072
Name:PECK, JANINE S
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:S
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 SANDY SPRINGS CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3832
Mailing Address - Country:US
Mailing Address - Phone:404-256-5194
Mailing Address - Fax:404-256-5151
Practice Address - Street 1:6022 SANDY SPRINGS CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3832
Practice Address - Country:US
Practice Address - Phone:404-256-5194
Practice Address - Fax:404-256-5151
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003478231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64BCBNTMedicare ID - Type Unspecified