Debra J Peacock, CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP007426 Issued in GA

Practice address

300 Sunset Cir
Moultrie, GA 31768-6934

Phone

(229) 985-2080

Fax

(229) 890-3397

NPI assigned

Jun 21, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Regional Therapy Services Inc

  • Rehabilitation Clinic/Center
  • Moultrie, GA
  • NPI 1528024387

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1154760296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 BUCK TRL",
            "city": "ELLERSLIE",
            "state": "GA",
            "postal_code": "318075219",
            "telephone_number": "706-566-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SUNSET CIR",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686934",
            "telephone_number": "229-985-2080",
            "fax_number": "229-890-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "DEBRA",
        "middle_name": "J",
        "credential": "CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP007426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "SLP007426",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Pate
• Dylan Patel
• Jaymal R Patel, M.D.
• Sager Pattani
• Marian Antoinette Patterson, MD
• Richard Anthony Peckham, RN
• Allyson Vichetra Pel, DO
• Perform Physical Therapy & Wellness LLC
• Rebecca H Peters, NP
• Makita Phillips

• All providers in Moultrie, GA
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.