Active NPI
Kevin George Peterson, PT, DPT
- Physical Therapist
- McDonough, GA
National Provider Identifier
1215466321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT012877
- Practice address
- 898 Hampton Rd
McDonough, GA 30253-6514 - Phone
- (678) 583-9954
- Fax
- (678) 583-8709
- NPI assigned
- Jun 12, 2017
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | PT012877 | GA | Primary |
Addresses
Primary practice location
898 Hampton Rd
McDonough, GA 30253-6514
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-8907
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT012877 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497225600000",
"number": "1215466321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6397 LEE HWY STE 300",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374212564",
"telephone_number": "423-238-8907",
"fax_number": "423-362-8684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "898 HAMPTON RD",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536514",
"telephone_number": "678-583-9954",
"fax_number": "678-583-8709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KEVIN",
"middle_name": "GEORGE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT012877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.