Provider Demographics
NPI:1457328098
Name:PEEPLES, JOHNNY R (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:R
Last Name:PEEPLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 FIR ST
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-3530
Mailing Address - Country:US
Mailing Address - Phone:478-374-1541
Mailing Address - Fax:478-374-1478
Practice Address - Street 1:1223 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6763
Practice Address - Country:US
Practice Address - Phone:478-374-3814
Practice Address - Fax:478-374-1478
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000430636CMedicaid
GA000430636AMedicaid