Healthcare Provider Details

I. General information

NPI: 1235112947
Provider Name (Legal Business Name): PETER W TROTTIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 KENNESTONE HOSPITAL BLVD SUITE 201
MARIETTA GA
30060-1161
US

IV. Provider business mailing address

320 KENNESTONE HOSPITAL BLVD SUITE 201
MARIETTA GA
30060-1161
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-2457
  • Fax: 770-427-2706
Mailing address:
  • Phone: 770-427-2457
  • Fax: 770-427-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: