Provider Demographics
NPI:1013918457
Name:PEROFSKY, HOWARD J (M D)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:PEROFSKY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 HEMLOCK ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6883
Mailing Address - Country:US
Mailing Address - Phone:478-742-4847
Mailing Address - Fax:478-742-5442
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6883
Practice Address - Country:US
Practice Address - Phone:478-742-4847
Practice Address - Fax:478-742-5442
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0324522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000410473AMedicaid
GA240002535OtherRETIRED RAILROAD MEDICARE
GA319715Medicaid
GA581859020OtherGEORGIA BLUE SHIELD
GA581859020OtherUNITED HEALTHCARE
GA581859020OtherAETNA HEALTH PLANS
GA581859020OtherHUMANA
GA581859020OtherCIGNA
GA581859020OtherTRICARE/CHAMPUS
GA581859020OtherCIGNA
GA000410473AMedicaid
GA581859020OtherGEORGIA BLUE SHIELD