Active NPI
Justin Peterson, MD
- Obstetrics & Gynecology Physician
- Douglas, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 079895
- Practice address
- 2010 Ocilla Rd
Douglas, GA 31533-2230 - Phone
- (912) 384-2500
- Fax
- (912) 383-6788
- NPI assigned
- Aug 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 079895 | GA | Primary |
Addresses
Primary practice location
2010 Ocilla Rd
Douglas, GA 31533-2230
Mailing address
2010 Ocilla Rd
Douglas, GA 31533-2230
Phone (912) 384-2500
Other practice location 1
11 Cross St
Hazlehurst, GA 31539-6427
Phone (912) 384-2500
Other practice location 2
1050 Valdosta Hwy
Homerville, GA 31634-9701
Phone (912) 384-2500
Other practice location 3
1724A Old Reynolds St
Waycross, GA 31501-1036
Phone (912) 384-1477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Mercer University School of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2010 Ocilla Rd
Douglas, GA 31533-2230
Phone (912) 384-2500
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CRH Physician Practices, LLC | Current | Accepting new patients | |
| CRH Physician Practices LLC | Past | Accepting new patients | |
| Coffee Regional Medical Center, Inc | Past | Accepting new patients |
Locations
2010 Ocilla Rd
Douglas, GA 31533
Phone (912) 384-1477
11 Cross St
Hazlehurst, GA 31539
Phone (912) 375-2884
1050 Valdosta Hwy
Homerville, GA 31634
Phone (912) 383-6575
1724A Old Reynolds St
Waycross, GA 31501
Phone (912) 383-6575
1508 Tebeau St
Waycross, GA 31501
Phone (912) 383-6575
Interoperability endpoints
- justin.peterson.1@9964.direct.athenahealth.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba CRH Pain Management
- Multi-Specialty Clinic/Center
- Douglas, GA
- NPI 1710046073
-
dba Coffee Regional Medical Center
- General Acute Care Hospital
- Douglas, GA
- NPI 1760419527
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Coffee Regional Medical Center
- General Acute Care Hospital
- Douglas, GA
- NPI 1760419527
-
dba Memorial Satilla Health
- Rural Acute Care Hospital
- Waycross, GA
- NPI 1922530468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556323200000",
"number": "1073893616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2010 OCILLA RD",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315332230",
"telephone_number": "912-384-2500",
"fax_number": "912-383-6788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 OCILLA RD",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315332230",
"telephone_number": "912-384-2500",
"fax_number": "912-383-6788"
}
],
"practiceLocations": [
{
"address_1": "11 Cross St",
"address_purpose": "LOCATION",
"city": "Hazlehurst",
"state": "GA",
"postal_code": "315396427",
"country_code": "US",
"telephone_number": "912-384-2500",
"fax_number": "912-383-6788",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1050 Valdosta Hwy",
"address_purpose": "LOCATION",
"city": "Homerville",
"state": "GA",
"postal_code": "316349701",
"country_code": "US",
"telephone_number": "912-384-2500",
"fax_number": "912-383-6788",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1724A Old Reynolds St",
"address_purpose": "LOCATION",
"city": "Waycross",
"state": "GA",
"postal_code": "315011036",
"country_code": "US",
"telephone_number": "912-384-1477",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "JUSTIN",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-26",
"last_updated": "2019-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "GA",
"license": "079895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.