Individual
BARBARA T PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 HARRIS INDUSTRIAL BLVD, STE C, VIDALIA, GA 30474-8852
(912) 537-1014
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R085963
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000845115B
—
GA
Enumeration date
04/10/2006
Last updated
05/16/2022
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