Individual
DEBRA J PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC/SLP
Contact information
Practice address
300 SUNSET CIR, MOULTRIE, GA 31768-6934
(229) 985-2080
(229) 890-3397
Mailing address
114 BUCK TRL, ELLERSLIE, GA 31807-5219
(706) 566-4867
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007426
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP007426
STATE LICENSE
GA
Enumeration date
06/21/2013
Last updated
06/21/2013
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