Provider Demographics
NPI:1851180624
Name:PEAVY, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PEAVY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001-4435
Mailing Address - Country:US
Mailing Address - Phone:229-467-2101
Mailing Address - Fax:
Practice Address - Street 1:124 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001-4435
Practice Address - Country:US
Practice Address - Phone:229-467-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH009402310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility