Healthcare Provider Details

I. General information

NPI: 1184123812
Provider Name (Legal Business Name): ALEX WHITMAN PETERSON PHMNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HUNTCLIFF STE 1350
ATLANTA GA
30350-1809
US

IV. Provider business mailing address

1010 HUNTCLIFF STE 1350
ATLANTA GA
30350-1809
US

V. Phone/Fax

Practice location:
  • Phone: 404-736-1410
  • Fax:
Mailing address:
  • Phone: 404-736-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN202524
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN202524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: