Healthcare Provider Details

I. General information

NPI: 1932224466
Provider Name (Legal Business Name): PETER DEZIEL ASST. V.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 ATLANTA AVE
HAPEVILLE GA
30354-1706
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD
FRANKLIN TN
37067-2626
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-4066
  • Fax:
Mailing address:
  • Phone: 615-778-4066
  • Fax: 615-778-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberPT006592
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: