Provider Demographics
NPI:1891535571
Name:TEAVER, PEIGHTON A
Entity type:Individual
Prefix:
First Name:PEIGHTON
Middle Name:A
Last Name:TEAVER
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 1:240 CANUP RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4500
Mailing Address - Country:US
Mailing Address - Phone:678-877-5194
Mailing Address - Fax:
Practice Address - Street 1:400 LAKE DOW RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2926
Practice Address - Country:US
Practice Address - Phone:770-865-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician