MEDICARE: DR. SOPHIA BROTHERS PETERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	026913	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3000122061	OTHER	GA	RAILROAD MEDICARE
2	P00096724	OTHER	GA	RIALROAD MEDICARE
3	300122060	OTHER	GA	RAILROAD MEDICARE
5	202G708830	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114901873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA BROTHERS PETERMAN M.D.

Provider Business Mailing Address
First Line	:	487 BURLINGTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1103
Country	:	US
Telephone Number	:	404-676-0482
Fax Number	:	404-378-1843

Provider Business Practice Location Address
First Line	:	487 BURLINGTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1103
Country	:	US
Telephone Number	:	404-667-0482
Fax Number	:	404-378-1843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	04/25/2018

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