Provider Demographics
NPI:1407166598
Name:MCCOMAS, PEGGY JO (LPN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:MCCOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MOSS LN
Mailing Address - Street 2:
Mailing Address - City:EUHARLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30145-2762
Mailing Address - Country:US
Mailing Address - Phone:770-334-8807
Mailing Address - Fax:
Practice Address - Street 1:25 MOSS LN
Practice Address - Street 2:
Practice Address - City:EUHARLEE
Practice Address - State:GA
Practice Address - Zip Code:30145-2762
Practice Address - Country:US
Practice Address - Phone:770-334-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5148443164W00000X
GA77271164W00000X
TX229118164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse