Provider Demographics
NPI:1891976700
Name:PEAVEY, ALICA ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALICA
Middle Name:ANN
Last Name:PEAVEY
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:400 TOWER RD NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6955
Mailing Address - Country:US
Mailing Address - Phone:770-590-1078
Mailing Address - Fax:770-422-7306
Practice Address - Street 1:400 TOWER RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6955
Practice Address - Country:US
Practice Address - Phone:770-590-1078
Practice Address - Fax:770-422-7306
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2008-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN143241 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily