Basic Information
| Provider Information | |||||||||
| NPI: | 1114474673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEACHEY | ||||||||
| FirstName: | TRENT | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 GA HIGHWAY 27 E | ||||||||
| Address2: | |||||||||
| City: | AMERICUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317093800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299248082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 GA HIGHWAY 27 E | ||||||||
| Address2: | |||||||||
| City: | AMERICUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317093800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299248082 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN 222478 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 003183526A | 05 | GA | MEDICAID | RN222478 | 01 | GA | APRN | OTHER |