MEDICARE: GEMARCO PETERSON

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	101Y00000X	Counselor	178.022601	IL

General Provider Information

NPI Number	:	1326906215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEMARCO PETERSON

Provider Business Mailing Address
First Line	:	1000 SPRING ST NW UNIT 1103
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SPRING ST NW UNIT 1103
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4923
Country	:	US
Telephone Number	:	832-563-3555
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ GEMARCO PETERSON ” Practice Location

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