Healthcare Provider Details

I. General information

NPI: 1184910481
Provider Name (Legal Business Name): CHRISTOPHER THOMAS PETERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6382
  • Fax: 678-843-4969
Mailing address:
  • Phone: 404-778-6382
  • Fax: 678-843-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO00768
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83214
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: