Provider Demographics
NPI:1356593461
Name:FITZGERALD MURRY, PEGGY ANN (DO)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:ANN
Last Name:FITZGERALD MURRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 SENOIA RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1622
Mailing Address - Country:US
Mailing Address - Phone:770-774-8787
Mailing Address - Fax:770-774-8785
Practice Address - Street 1:1134 SENOIA RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1622
Practice Address - Country:US
Practice Address - Phone:770-774-8787
Practice Address - Fax:770-774-8785
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCGMVMedicare PIN