MR. CHARLES LEROY PEACOCK (NPI# 1063548964) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063548964 |
| Entity Type | Individual |
| Full Name | MR. CHARLES LEROY PEACOCK |
| Credential | CRNA |
| Practice Address |
1000 Medical Center Blvd Lawrenceville GA 30045-7694 |
| Mailing Address |
840 Connell Ln Lawrenceville GA 30044-6123 |
| Practice Telephone | 6784424321 |
| Mailing Telephone | 7707365173 |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | RN182133 CRNA | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1000 MEDICAL CENTER BLVD |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30045-7694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942203757 | Peter J Kaplan | Specialist | 1000 Medical Center Blvd, Lawrenceville, GA 30045-7694 | 2005-05-24 |
| 1780281469 | Khatija Jivani | Pharmacist | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-10-06 |
| 1780298356 | Jennifer Nicole Venable | Anesthesiologist Assistant | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-09-01 |
| 1639782378 | Tehzeeb Babwani | Anesthesiologist Assistant | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-08-24 |
| 1801417480 | Northside Hospital Inc | Pharmacy | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-05-05 |
| 1851929996 | Mclean Davies | Student in an Organized Health Care Education/Training Program | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-04-01 |
| 1861029423 | Jaemi Chu | Internal Medicine | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-24 |
| 1548897267 | Sharul Saxena | Internal Medicine | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-24 |
| 1235766148 | Nahayo Esperant-hilaire | Student in an Organized Health Care Education/Training Program | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-23 |
| 1982239596 | Riley Claire Cullen | Nurse Practitioner | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285104315 | Shalanda Monique Booker | Counselor | 2940 Emerald Springs Drive, Lawrenceville, GA 30045 | 2018-12-02 |
| 1669957320 | Chantelle S Fuller | Behavioral Analyst | 805 Donington Cir, Lawrenceville, GA 30045 | 2018-09-28 |
| 1356836035 | Gad Health Care LLC | Home Health | 1140 Great Oaks Dr, Lawrenceville, GA 30045 | 2018-06-26 |
| 1346668662 | Eca Optical, LLC | Eyewear Supplier (Equipment, not the service) | 601-a Professional Drive, Ste 170, Lawrenceville, GA 30045 | 2014-04-03 |
| 1598102733 | Selena Fuller | Nurse Practitioner | 181 South Clayton Street, Lawrenceville, GA 30045 | 2013-05-29 |
| 1942555982 | Vida Michele James-bryant | Community Health Worker | 1309 Avington Glen Dr, Lawrenceville, GA 30045 | 2012-07-16 |
| 1770840639 | Rebecca Vinson D'angelo | Occupational Therapist | 1518 Great Shoals Cir, Lawrenceville, GA 30045 | 2012-04-17 |
| 1427346774 | Amanda Michelel Woods | Psychologist | 285 South Perry Street, Lawrenceville, GA 30045 | 2011-07-20 |
| 1790070563 | M & G Pharmacy Inc | Pharmacy | 100 Hurricane Shoals Rd Suite F, Lawrenceville, GA 30045 | 2011-06-09 |
| 1306146154 | Thanh Dau | Optometrist | 1250 Scenic Highway, Ste 1268, Lawrenceville, GA 30045 | 2010-10-27 |
| Find all providers in zip 30045 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497227797 | Mustapha Timmy Issa | Nurse Anesthetist, Certified Registered | 1403 Elderberry Run Cv, Lawrenceville, GA 30043-3999 | 2018-12-26 |
| 1548730179 | Alexis Nicole Robinson | Nurse Anesthetist, Certified Registered | 1000 Medical Center Boulevard, Lawrenceville, GA 30046 | 2018-11-27 |
| 1528059755 | Michael Alexander Geisler | Nurse Anesthetist, Certified Registered | 1605 Lakes Pkwy, Lawrenceville, GA 30043-5858 | 2005-11-05 |
| 1295369205 | Janelle Denise Meadows | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-02-28 |
| 1306326327 | Annmarie Kathleen Bodnia | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2018-08-20 |
| 1578067179 | Dominique Daielle Peart | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2018-03-20 |
| 1750899811 | Kate Chang | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2018-01-11 |
| 1235645011 | Lyndsey Cole | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2017-12-15 |
| 1326591397 | Shabnam Samsuddin | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2016-07-26 |
| 1962863084 | Liliana Rascon | Nurse Anesthetist, Certified Registered | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2016-03-17 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30045 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.