Healthcare Provider Details

I. General information

NPI: 1629038476
Provider Name (Legal Business Name): PETER BEMIS H'DOUBLER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD NE SUITE 675
ATLANTA GA
30342-1731
US

IV. Provider business mailing address

1838 AMERICAN WAY
LAWRENCEVILLE GA
30043-6611
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-5400
  • Fax: 678-843-5449
Mailing address:
  • Phone: 770-995-7622
  • Fax: 770-995-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number034609
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: