Individual
MICHAEL SHANNON PEATTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
859 WINTER ST, LUCEDALE, MS 39452-6603
(601) 947-3161
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(228) 327-5453
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26508
AL
207R00000X
Internal Medicine Physician
Primary
16500
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051526716
—
AL
05
—
06800711
—
MS
01
—
51526716
BCBS
AL
Enumeration date
06/19/2006
Last updated
02/07/2012
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