Peter Keith Re, M.D.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

011454 Issued in GA

Practice address

780 Canton Road NE
Suite 400
Marietta, GA 30060-7241

Phone

(770) 422-3602

Fax

(770) 421-6115

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1124111208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CANTON ROAD NE",
            "address_2": "SUITE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607241",
            "telephone_number": "770-422-3602",
            "fax_number": "770-421-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 CANTON ROAD NE",
            "address_2": "SUITE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607241",
            "telephone_number": "770-422-3602",
            "fax_number": "770-421-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RE",
        "first_name": "PETER",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "GA",
            "license": "011454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.