Provider Demographics
NPI:1063582724
Name:SEAN B PEPPARD MD PC
Entity type:Organization
Organization Name:SEAN B PEPPARD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-743-4717
Mailing Address - Street 1:PO BOX 4867
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4867
Mailing Address - Country:US
Mailing Address - Phone:478-743-4717
Mailing Address - Fax:478-743-7955
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:SUITE 800
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2100
Practice Address - Country:US
Practice Address - Phone:478-743-4717
Practice Address - Fax:478-743-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty