Basic Information
| Provider Information | |||||||||
| NPI: | 1093710196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEPPARD | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | RHODA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 MARGIE DR | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789532705 | ||||||||
| FaxNumber: | 4789532857 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 MARGIE DR | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789532705 | ||||||||
| FaxNumber: | 4789532857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD001218 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | AUD001218 | GA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 000799906B | 05 | GA | MEDICAID | 000799906H | 05 | GA | MEDICAID | 000799906G | 05 | GA | MEDICAID | 000799906E | 05 | GA | MEDICAID |