Active NPI
Stephen Wallace Peacock
- Physical Therapy Assistant
- Savannah, GA
National Provider Identifier
1093516577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA003459
- Practice address
- 2040 Colonial Dr
Savannah, GA 31406-2226 - Phone
- (912) 354-2752
- NPI assigned
- Mar 21, 2025
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA003459 | GA | Primary |
Addresses
Primary practice location
2040 Colonial Dr
Savannah, GA 31406-2226
Mailing address
110 Richmond Walk Dr
Richmond Hill, GA 31324-6921
Phone (912) 321-7907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA003459 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742515200000",
"number": "1093516577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 RICHMOND WALK DR",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313246921",
"telephone_number": "912-321-7907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 COLONIAL DR",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314062226",
"telephone_number": "912-354-2752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "STEPHEN",
"middle_name": "WALLACE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-03-21",
"last_updated": "2025-03-21",
"certification_date": "2025-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA003459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.