Provider Demographics
NPI:1083196836
Name:PILOTE, PETA-GAYE C (RN)
Entity Type:Individual
Prefix:MRS
First Name:PETA-GAYE
Middle Name:C
Last Name:PILOTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 REGAL WAY E
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8248
Mailing Address - Country:US
Mailing Address - Phone:678-559-2488
Mailing Address - Fax:
Practice Address - Street 1:319 REGAL WAY E
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:678-559-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249535163WC1500X
320800000X
GAPCH007436320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness