MEDICARE: PETER WILLIAM POSSERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	049864	GA

General Provider Information

NPI Number	:	1184677098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER WILLIAM POSSERT MD

Provider Business Mailing Address
First Line	:	275 PROFESSIONAL CT
Second Line	:	SUITE B
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2531
Country	:	US
Telephone Number	:	770-907-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE T10
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8017
Country	:	US
Telephone Number	:	770-721-9000
Fax Number	:	770-721-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/10/2021

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