Individual
MR. CHARLES LEROY PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30045-7694
(678) 442-4321
Mailing address
840 CONNELL LN, LAWRENCEVILLE, GA 30044-6123
(770) 736-5173
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN182133 CRNA
GA
Other
Enumeration date
02/26/2007
Last updated
07/08/2007
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