Provider Demographics
NPI:1629038476
Name:H'DOUBLER, PETER BEMIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BEMIS
Last Name:H'DOUBLER
Suffix:JR
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 1:1838 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6611
Mailing Address - Country:US
Mailing Address - Phone:770-995-7622
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 675
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:678-843-5400
Practice Address - Fax:678-843-5449
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0346092086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000460039RMedicaid
GA000460039NMedicaid
GA000460039OMedicaid
GA000460039QMedicaid
GA000460039MMedicaid
GA000460039PMedicaid
GA000460039KMedicaid
GA000460039LMedicaid
GA000460039IMedicaid
GA000460039JMedicaid
GA00460039EMedicaid
GA000460039PMedicaid
GAE10085Medicare UPIN
GA000460039IMedicaid