Individual
NAQUIESHA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3510 PONDEROSA LN, POWDER SPRINGS, GA 30127-2074
(470) 339-6500
Mailing address
3510 PONDEROSA LN, POWDER SPRINGS, GA 30127-2074
(470) 339-6500
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO136709
PROSTHETIC SPECIALIST
GA
Enumeration date
03/08/2020
Last updated
03/08/2020
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