Provider Demographics
NPI:1215936828
Name:PETERS, GEOFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 EISENHOWER DR
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-527-5300
Mailing Address - Fax:912-527-5154
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:BLDG. 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5300
Practice Address - Fax:912-527-5154
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039438207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000636732EMedicaid
SCG39438Medicaid
GA006160OtherBCBS
GA000636732FMedicaid
GA060070776OtherRR MEDICARE
GA000636732EMedicaid
SCG39438Medicaid