Healthcare Provider Details

I. General information

NPI: 1831362037
Provider Name (Legal Business Name): WALTER HAMILTON PETERS IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAMILTON PETERS M.D.

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK SUITE 420
COLUMBIA SC
29203-8004
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6050
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number39207
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: