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General NPI Number Information
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NPI Number | 1477153955
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Entity Type | Individual
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Provider Name | DR. PETERSON ALCIDE
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 166 ANDERSON ST SE STE 225
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City | MARIETTA
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State | GA
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Zip | 30060-1984
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Country | US
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Telephone | 203-501-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 166 ANDERSON ST SE STE 225
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City | MARIETTA
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State | GA
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Zip | 30060-1984
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Country | US
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Telephone | 203-501-6553
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Fax |
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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 | 246Y00000X
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Taxonomy Name | Health Information Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State | GA
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