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NPI Code Detail

MEDICARE: GERALD PETERMAN NP

MEDICARE: GERALD PETERMAN NP
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
1363L00000XNurse PractitionerRN122988GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649289653
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD PETERMAN NP
Provider Business Mailing Address
First Line : 409 HERITAGE DR
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31093-6621
Country : US
Telephone Number : 478-922-7954
Fax Number :
Provider Business Practice Location Address
First Line : 2054 WATSON BLVD
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31093-3634
Country : US
Telephone Number : 478-633-2097
Fax Number : 478-633-7836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 12/17/2012

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Directions to “ GERALD PETERMAN NP” Practice Location

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