Provider Demographics
NPI:1023726080
Name:PEACE, TREVA S (AGNPC)
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:S
Last Name:PEACE
Suffix:
Gender:F
Credentials:AGNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 RANDOLPH STILL RD
Mailing Address - Street 2:
Mailing Address - City:GOOD HOPE
Mailing Address - State:GA
Mailing Address - Zip Code:30641-2132
Mailing Address - Country:US
Mailing Address - Phone:678-431-7487
Mailing Address - Fax:
Practice Address - Street 1:2389 RANDOLPH STILL RD
Practice Address - Street 2:
Practice Address - City:GOOD HOPE
Practice Address - State:GA
Practice Address - Zip Code:30641-2132
Practice Address - Country:US
Practice Address - Phone:678-431-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281405163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse