Provider Demographics
NPI:1124298252
Name:PECK, GREGORY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WAYNE
Last Name:PECK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1765 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5969
Mailing Address - Country:US
Mailing Address - Phone:770-914-6781
Mailing Address - Fax:770-914-6874
Practice Address - Street 1:1765 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5969
Practice Address - Country:US
Practice Address - Phone:770-914-6781
Practice Address - Fax:770-914-6874
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist