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General NPI Number Information
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NPI Number | 1306076021
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Entity Type | Individual
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Provider Name | REGINALD DEMETRIUS PEEK MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 950 INDIAN TRL RD NW SUITE 5D
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City | LILBURN
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State | GA
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Zip | 30047-1721
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Country | US
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Telephone | 404-600-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 LAUREL CIR NW
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City | ATLANTA
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State | GA
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Zip | 30311-1237
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Country | US
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Telephone | 404-277-9264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 063002
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License Number State | GA
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