Basic Information
Provider Information | |||||||||
NPI: | 1023012010 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRITT | ||||||||
FirstName: | PETER | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 15759 | ||||||||
Address2: |   | ||||||||
City: | SAVANNAH | ||||||||
State: | GA | ||||||||
PostalCode: | 314162459 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9123558188 | ||||||||
FaxNumber: | 9123566970 | ||||||||
Practice Location | |||||||||
Address1: | 4700 WATERS AVE | ||||||||
Address2: |   | ||||||||
City: | SAVANNAH | ||||||||
State: | GA | ||||||||
PostalCode: | 314046220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9123508436 | ||||||||
FaxNumber: | 9123566970 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2005 | ||||||||
LastUpdateDate: | 03/30/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/29/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | 047057 | GA | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0204X | 047057 | GA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
ID | Type | State | Issuer | Description | 000826834N | 01 | GA | PEACH STATE HEALTH PLAN | OTHER | 000826834N | 05 | GA |   | MEDICAID | N343829 | 01 | GA | WELLCARE | OTHER | P00266283 | 01 | GA | RAILROAD MEDICARE | OTHER | 52666903015 | 01 | GA | BCBS | OTHER |