NPI Code Detail JSON Logo

1942898473 NPI number — FANESHIA PETERSON FNP

NPI Number: 1942898473
Health Care Provider/Practitioner: FANESHIA PETERSON FNP

Information about “1942898473” NPI (FANESHIA PETERSON FNP) exists in 1942898473 in HTML format HTML  |  1942898473 in plain Text format TXT  |  1942898473 in PDF (Portable Document Format) PDF  |  1942898473 in an XML format XML  formats.

NPI Number : 1942898473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942898473",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "FANESHIA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "289 JONESBORO RD STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCDONOUGH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30253-3725",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "470-641-5996",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4475 W VILLAGE PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELLENWOOD",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30294-2869",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-507-7950",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/11/2021",
    "LastUpdateDate": "11/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/20/2021",
    "NPIReactivationDate": "07/12/2021",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN-NP259066",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "259066",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.