MEDICARE: DANIELS EARL PETERS

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1215491691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELS EARL PETERS

Provider Business Mailing Address
First Line	:	3114 ASBURY SQ
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-2421
Country	:	US
Telephone Number	:	239-321-9007
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 ASBURY SQ
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-2421
Country	:	US
Telephone Number	:	239-321-9007
Fax Number	:

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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