Provider Demographics
NPI:1053733899
Name:PEAVY, ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PEAVY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6724
Mailing Address - Country:US
Mailing Address - Phone:678-438-9966
Mailing Address - Fax:
Practice Address - Street 1:1228 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036
Practice Address - Country:US
Practice Address - Phone:678-438-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA214059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse