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General NPI Number Information
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NPI Number | 1093767998
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Entity Type | Individual
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Provider Name | MARCIA JEAN PETERS FNP,BC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 141 E COLLEGE AVE
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City | DECATUR
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State | GA
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Zip | 30030-3770
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Country | US
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Telephone | 404-471-6348
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Fax | 404-471-6498
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Provider Business Mailing Address
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Address Line | 212 HEATHERDOWN ROAD
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City | DECATUR
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State | GA
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Zip | 30030-3770
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Country | US
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Telephone | 404-372-7319
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Fax | 404-471-6498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN139529
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License Number State | GA
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