1720321631 NPI number — DR. LYNNE DUNNINGTON PEAVEY AU.D.

Table of content: DR. LYNNE DUNNINGTON PEAVEY AU.D. (NPI 1720321631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720321631 NPI number — DR. LYNNE DUNNINGTON PEAVEY AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEAVEY
Provider First Name:
LYNNE
Provider Middle Name:
DUNNINGTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720321631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 E KNIGHT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30116-7936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-841-3698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5455 MERIDIAN MARK RD SUITE 130
Provider Second Line Business Practice Location Address:
PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-4277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-255-2033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AUD001853 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)