Provider Demographics
NPI:1104401744
Name:PEAKE-BROWN, LAKEISHA
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:PEAKE-BROWN
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 1:176 SNOW BIRD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3528
Mailing Address - Country:US
Mailing Address - Phone:404-822-0819
Mailing Address - Fax:
Practice Address - Street 1:2570 BLACKMON DR STE 440-12
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6196
Practice Address - Country:US
Practice Address - Phone:404-822-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247895163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice