Peacock, Michael Todd

Peacock, Michael Todd is an individual health care provider with primary practice located at 911 Plaza Ave Suite C, Eastman GA 31023-6785. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Peacock, Michael Todd can be contacted via phone (478) 374-5774.

Contact Information

Primary practice address
911 Plaza Ave Suite C Eastman GA 31023-6785
Phone: (478) 374-5774
Fax: (478) 374-9112
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 040752 Georgia
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 040752 Georgia

Profile Details

NPI number 1487636742
LBN Legal business name Peacock, Michael Todd
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2005
Last updated Dec 12th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487636742 NPPES
Georgia MEDICAID 00742409A

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