Individual
DR. KEVIN H PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 MILSTEAD RD NE, SUITE 110, CONYERS, GA 30012-3838
(770) 760-9949
(770) 760-9951
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 495-3396
(770) 495-2307
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
2004-00941
NC
207RH0003X
Hematology & Oncology Physician
Primary
064241
GA
207RX0202X
Medical Oncology Physician
200400941
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119857791A
—
GA
01
—
145JC
BCBS
NC
05
—
1679686661
—
VA
01
—
199212
MEDCOST
NC
05
—
3810009045
—
WV
05
—
5905021
—
NC
01
—
7119766
AETNA
NC
01
—
808364
PARTNERS
NC
05
—
Q0094F
—
SC
Enumeration date
08/16/2006
Last updated
03/09/2021
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