Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Matthew Shane Peterson, MD

Individual provider Obstetrics & Gynecology Physician · NPI 1255319828

Dr. Matthew Shane Peterson, MD is an Obstetrics/Gynecology in Kennesaw, Georgia. Graduated from University of Tennessee, Hsc, College of Medicine in 1997, 29 years ago. Practices with The Southeast Permanente Medical Group, a 826-clinician group and accepts Medicare assignment. Licensed in Georgia and North Carolina.

Years since qualifying
29
Trained at
University of Tennessee, Hsc, College of Medicine
Licensed in
GA, NC
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

750 Townpark Ln NW
Kennesaw, GA 30144-5579
Phone: (404) 365-0966
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence 85640 (GA)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 200200772 (NC)

Record details

NPI number1255319828
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJanuary 4, 2006
Last updated in NPPESJanuary 22, 2025
Certification dateDecember 23, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolUNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Graduated 1997 (29 years in practice)
Group practice The Southeast Permanente Medical Group — 826 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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