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NPI Code Detail

MEDICARE: DIANE PETERMAN MD

MEDICARE: DIANE PETERMAN 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
1207P00000XEmergency Medicine Physician209484NY
2207Q00000XFamily Medicine Physician95057GA

General Provider Information

NPI Number : 1740310044
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE PETERMAN MD
Provider Business Mailing Address
First Line : 1838 AMERICAN WAY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-6611
Country : US
Telephone Number : 770-841-1954
Fax Number :
Provider Business Practice Location Address
First Line : 119 HARMONY XING STE 3
Second Line :
City : EATONTON
State : GA
Zip : 31024-9571
Country : US
Telephone Number : 706-485-4004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 05/01/2024

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Directions to “ DIANE PETERMAN MD” Practice Location

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