Provider Demographics
NPI:1790932226
Name:JOANNE S PEELER PHD
Entity Type:Organization
Organization Name:JOANNE S PEELER PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-804-0890
Mailing Address - Street 1:1830 INDEPENDENCE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5165
Mailing Address - Country:US
Mailing Address - Phone:770-804-0890
Mailing Address - Fax:770-352-0830
Practice Address - Street 1:1830 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5165
Practice Address - Country:US
Practice Address - Phone:770-804-0890
Practice Address - Fax:770-352-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001617261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBCLJMedicare PIN
GAR70932Medicare UPIN