Provider Demographics
NPI:1932211315
Name:BOOHER, PEGGY WEBB (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:WEBB
Last Name:BOOHER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DAWSON COMMONS CIR
Mailing Address - Street 2:STE. 320
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6268
Mailing Address - Country:US
Mailing Address - Phone:706-216-2770
Mailing Address - Fax:706-216-2944
Practice Address - Street 1:300 DAWSON COMMONS CIR
Practice Address - Street 2:STE. 320
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6268
Practice Address - Country:US
Practice Address - Phone:706-216-2770
Practice Address - Fax:706-216-2944
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076497 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10037015OtherAMERIGROUP
GA877805218BMedicaid