Provider Demographics
NPI:1679686661
Name:PEACOCK, KEVIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:H
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:1501 MILSTEAD RD NE
Practice Address - Street 2:SUITE 110
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3838
Practice Address - Country:US
Practice Address - Phone:770-760-9949
Practice Address - Fax:770-760-9951
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200400941207RX0202X
GA064241207RH0003X
NC2004-00941207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0094FMedicaid
WV3810009045Medicaid
GA119857791AMedicaid
NC5905021Medicaid
NC7119766OtherAETNA
NC808364OtherPARTNERS
NC145JCOtherBCBS
VA1679686661Medicaid
NC199212OtherMEDCOST
SCQ0094FMedicaid
NC5905021Medicaid
NC145JCOtherBCBS