Provider Demographics
NPI:1952189730
Name:PEACE ACADEMY CHARTERSCHOOL
Entity Type:Organization
Organization Name:PEACE ACADEMY CHARTERSCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYESE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:470-722-0706
Mailing Address - Street 1:1954 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4225
Mailing Address - Country:US
Mailing Address - Phone:470-722-0706
Mailing Address - Fax:
Practice Address - Street 1:1954 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4225
Practice Address - Country:US
Practice Address - Phone:470-722-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health