Individual
DR. MATTHEW SHANE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(404) 365-0966
Mailing address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(404) 365-0966
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
200200772
NC
207V00000X
Obstetrics & Gynecology Physician
Primary
85640
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89132R9
—
NC
Enumeration date
01/04/2006
Last updated
01/22/2025
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