Active NPI
Grant Allen Peacock III, PT
- Specialist
- Tucker, GA
National Provider Identifier
1942411699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT001863
- Practice address
- 2627 Churchwell LN
Tucker, GA 30084-2412 - Phone
- (770) 491-8511
- Fax
- (770) 491-6914
- NPI assigned
- May 24, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | PT001863 | GA | Primary |
Addresses
Primary practice location
2627 Churchwell LN
Tucker, GA 30084-2412
Mailing address
2627 Churchwell LN
Tucker, GA 30084-2412
Phone (770) 491-8511
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 |
|---|---|---|---|
| PT001863 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942411699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2627 CHURCHWELL LN",
"city": "TUCKER",
"state": "GA",
"postal_code": "300842412",
"telephone_number": "770-491-8511",
"fax_number": "770-491-6914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2627 CHURCHWELL LN",
"city": "TUCKER",
"state": "GA",
"postal_code": "300842412",
"telephone_number": "770-491-8511",
"fax_number": "770-491-6914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "GRANT",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "PT001863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.