Provider Demographics
NPI:1982635546
Name:PEACOCK, GEORGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HURON ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 CLIFTON ROAD MAIL STOP E-87
Practice Address - Street 2:CENTERS FOR DISEASE CONTROL AND PREVENTION
Practice Address - City:ALANTA
Practice Address - State:GA
Practice Address - Zip Code:30333
Practice Address - Country:US
Practice Address - Phone:404-498-4347
Practice Address - Fax:404-498-3050
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-293992080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics