Individual
PETER VERNON EDBLAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
655 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3756
(770) 532-7092
(770) 534-8145
Mailing address
3032 SHADES VALLEY LN, GAINESVILLE, GA 30501-7438
(763) 670-5725
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
GA
363AS0400X
Surgical Physician Assistant
Primary
13447
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689554032
NPI
GA
Enumeration date
09/05/2025
Last updated
11/18/2025
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