MEDICARE: ALEX WHITMAN PETERSON PHMNP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN202524	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN202524	GA

General Provider Information

NPI Number	:	1184123812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX WHITMAN PETERSON PHMNP

Provider Business Mailing Address
First Line	:	1010 HUNTCLIFF STE 1350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-1809
Country	:	US
Telephone Number	:	404-736-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 HUNTCLIFF STE 1350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-1809
Country	:	US
Telephone Number	:	404-736-1410
Fax Number	:

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	01/22/2019

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