Provider Demographics
NPI:1265492326
Name:PETERS, JEFFRY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:JOHN
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:907 18TH ST E STE 400
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3684
Mailing Address - Country:US
Mailing Address - Phone:229-353-3422
Mailing Address - Fax:229-353-6060
Practice Address - Street 1:1815 OLD OCILLA RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1617
Practice Address - Country:US
Practice Address - Phone:229-391-3535
Practice Address - Fax:229-391-3529
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040514208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA447469OtherBLUE CROSS BLUE SHEILD
GA0068177AMedicaid
GAE86649Medicare UPIN
GA34BDDVWMedicare ID - Type Unspecified