Individual
MR. PETER JEFF HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300 TOWER RD NE, SUITE 200, MARIETTA, GA 30060-9403
(770) 427-5717
(770) 429-6503
Mailing address
300 TOWER RD NE, SUITE 200, MARIETTA, GA 30060-9403
(770) 427-5717
(770) 429-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003530
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309477474A
—
GA
Enumeration date
10/18/2005
Last updated
08/13/2007
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