Provider Demographics
NPI:1720321631
Name:PEAVEY, LYNNE DUNNINGTON (AUD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:DUNNINGTON
Last Name:PEAVEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-7936
Mailing Address - Country:US
Mailing Address - Phone:770-841-3698
Mailing Address - Fax:
Practice Address - Street 1:5455 MERIDIAN MARK RD SUITE 130
Practice Address - Street 2:PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4277
Practice Address - Country:US
Practice Address - Phone:404-255-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD001853231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist