Provider Demographics
NPI:1598070112
Name:PEABODY, JEANNETTE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:PEABODY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 ASHLEYWOODS DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4310
Mailing Address - Country:US
Mailing Address - Phone:770-853-2075
Mailing Address - Fax:
Practice Address - Street 1:1547 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4008
Practice Address - Country:US
Practice Address - Phone:404-712-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse