MEDICARE: CHELSEA K PETERKIN - BONNER LCSW

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	1041C0700X	Clinical Social Worker	008953	GA

General Provider Information

NPI Number	:	1831943976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA K PETERKIN - BONNER LCSW

Provider Business Mailing Address
First Line	:	196 VIRGINIA AVE S # 1111
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-8073
Country	:	US
Telephone Number	:	205-588-4889
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 VIRGINIA AVE S # 1111
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-8073
Country	:	US
Telephone Number	:	205-588-4889
Fax Number	:

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	09/14/2025

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