Provider Demographics
NPI:1437678885
Name:PEAVY, TELEIGHA L
Entity Type:Individual
Prefix:MS
First Name:TELEIGHA
Middle Name:L
Last Name:PEAVY
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 1:2695 KINGSBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7392
Mailing Address - Country:US
Mailing Address - Phone:678-667-7988
Mailing Address - Fax:
Practice Address - Street 1:2695 KINGSBROOKE LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7392
Practice Address - Country:US
Practice Address - Phone:678-667-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052266804OtherDRIVER'S LICENSE