Individual
XAVIER DEON PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
260 NORTHERN AVE, AVONDALE ESTATES, GA 30002-1214
(716) 322-9408
Mailing address
1008 REDWOOD ST, PORT GIBSON, MS 39150-2593
(716) 322-9408
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN323385
GA
Other
Enumeration date
02/26/2024
Last updated
02/26/2024
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