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NPI Code Detail

MEDICARE: ERIC PEHR PETERSON CRNA

MEDICARE: ERIC PEHR PETERSON CRNA
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
1367500000XCertified Registered Nurse AnesthetistAPRN-CRNA223125GA

General Provider Information

NPI Number : 1952172405
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC PEHR PETERSON CRNA
Provider Business Mailing Address
First Line : 4886 ORCHARD HILL DR
Second Line :
City : GROVETOWN
State : GA
Zip : 30813-6323
Country : US
Telephone Number : 706-288-4728
Fax Number :
Provider Business Practice Location Address
First Line : 3651 WHEELER RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6426
Country : US
Telephone Number : 706-267-9129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2024
Last Update Date : 03/06/2026

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