Provider Demographics
NPI:1386972651
Name:OWENS-PEETE, ANTONETTE MICHELL
Entity type:Individual
Prefix:MS
First Name:ANTONETTE
Middle Name:MICHELL
Last Name:OWENS-PEETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 JOHNSON CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6459
Mailing Address - Country:US
Mailing Address - Phone:918-348-0821
Mailing Address - Fax:770-603-4020
Practice Address - Street 1:712 JOHNSON CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6459
Practice Address - Country:US
Practice Address - Phone:918-348-0821
Practice Address - Fax:770-603-4020
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA90-0919120OtherEMPLOYER IDENTIFICATION NUMBER