Provider Demographics
NPI:1376317230
Name:PEACHY SPEECHWORKS OF CENTRAL GA
Entity Type:Organization
Organization Name:PEACHY SPEECHWORKS OF CENTRAL GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:PUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-714-4128
Mailing Address - Street 1:145 DUB WALKER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-5430
Mailing Address - Country:US
Mailing Address - Phone:770-714-4128
Mailing Address - Fax:
Practice Address - Street 1:145 DUB WALKER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-5430
Practice Address - Country:US
Practice Address - Phone:770-714-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty