Provider Demographics
NPI:1841937133
Name:PEACE OF MINE
Entity type:Organization
Organization Name:PEACE OF MINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHSON-CHITOLIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-416-8899
Mailing Address - Street 1:3883 ROGERS BRIDGE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2849
Mailing Address - Country:US
Mailing Address - Phone:404-381-1178
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD STE 701
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2849
Practice Address - Country:US
Practice Address - Phone:404-381-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty