Individual
DR. MICHAEL TODD PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
911 PLAZA AVE, SUITE C, EASTMAN, GA 31023-6785
(478) 374-5774
(478) 374-9112
Mailing address
911 PLAZA AVE, SUITE C, EASTMAN, GA 31023-6785
(478) 374-5774
(478) 374-9112
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
040752
GA
207R00000X
Internal Medicine Physician
Primary
040752
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00742409A
—
GA
Enumeration date
11/14/2005
Last updated
12/12/2013
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