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General NPI Number Information
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NPI Number | 1538314828
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Entity Type | Organization
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Legal Business Name | DOC PEACOCKS GREENFIELD COUNTRY MEDICINE, PLLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 68 WEST AVE STE 3
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-6044
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Country | US
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Telephone | 518-450-9180
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Fax | 518-886-1690
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | GREENFIELD CENTER
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State | NY
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Zip | 12833-0159
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Country | US
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Telephone | 518-450-9180
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Fax | 518-886-1690
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. JAMA PEACOCK
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Credential | MD
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Telephone | 518-893-6075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 239931
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License Number State | NY
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