Provider Demographics
NPI:1114474673
Name:PEACHEY, TRENT JOSEPH
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:JOSEPH
Last Name:PEACHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GA HIGHWAY 27 E
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3800
Mailing Address - Country:US
Mailing Address - Phone:229-924-8082
Mailing Address - Fax:
Practice Address - Street 1:103 GA HIGHWAY 27 E
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3800
Practice Address - Country:US
Practice Address - Phone:229-924-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 222478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183526AMedicaid
GARN222478OtherAPRN