Healthcare Provider Details

I. General information

NPI: 1710140504
Provider Name (Legal Business Name): ALISON SUE PETERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 ROBERTA DR
BISHOP GA
30621-7308
US

IV. Provider business mailing address

1081 ROBERTA DR
BISHOP GA
30621-7308
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-0771
  • Fax:
Mailing address:
  • Phone: 706-769-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN088556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: