Milton Alex Peavey Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11881 Issued in GA

Practice address

408 Lister St
Waycross, GA 31501-5226

Phone

(912) 285-1212

Fax

(912) 287-0808

NPI assigned

May 2, 2007

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720209943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 ALEXIS LN",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315164744",
            "telephone_number": "912-338-9978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 LISTER ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015226",
            "telephone_number": "912-285-1212",
            "fax_number": "912-287-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEAVEY",
        "first_name": "MILTON",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "11881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nimi Patel
• Pathology Associates of Waycross
• Patricia Walker Host Home
• Laura M Pearson, LPC
• Lori Anne Pearson, NP
• Tammy Perritt, LAPC
• Peter Wrobel MD PC
• Amanda Gayle Petty, APRN
• Pharmacy Services Inc. (Larrys Pharmacy)
• Kari L Piestrak, HEARING AID DISPENSE

• General Practice Dentistry in Waycross, GA
• Providers in Waycross, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.