Individual
DR. PETERSON ALCIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
166 ANDERSON ST SE STE 225, MARIETTA, GA 30060-1984
(203) 501-6553
Mailing address
166 ANDERSON ST SE STE 225, MARIETTA, GA 30060-1984
(203) 501-6553
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
GA
101YM0800X
Mental Health Counselor
—
GA
132700000X
Dietary Manager
—
GA
225C00000X
Rehabilitation Counselor
—
GA
246QL0900X
Laboratory Management Specialist/Technologist
—
—
246Y00000X
Health Information Specialist/Technologist
—
—
2472E0500X
EEG Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477153955
—
GA
05
—
1609415132
—
GA
Enumeration date
10/26/2020
Last updated
06/21/2022
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