Individual
MR. MICHAEL PETROSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 VANN ST NE, STE 150, MARIETTA, GA 30060-7250
(770) 421-1242
(770) 424-6652
Mailing address
120 VANN ST NE, STE 150, MARIETTA, GA 30060-7250
(770) 421-1242
(770) 424-6652
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
030855
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24BCBBD
PROVIDER TRANSACTION ACCESS NUMBER-PTAN
GA
Enumeration date
08/31/2005
Last updated
07/09/2008
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