Provider Demographics
NPI:1093710196
Name:PEPPARD, ANNETTE RHODA (AU D)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:RHODA
Last Name:PEPPARD
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7817
Mailing Address - Country:US
Mailing Address - Phone:478-953-2705
Mailing Address - Fax:478-953-2857
Practice Address - Street 1:302 MARGIE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7817
Practice Address - Country:US
Practice Address - Phone:478-953-2705
Practice Address - Fax:478-953-2857
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001218231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000799906BMedicaid
GA000799906HMedicaid
GA000799906GMedicaid
GA000799906EMedicaid
GAS69402Medicare UPIN
GA000799906EMedicaid