Individual
DAVID ALLEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 W GORDON ST, THOMASTON, GA 30286-3426
(706) 647-8111
(706) 647-4389
Mailing address
PO BOX 589, THOMASTON, GA 30286-0008
(706) 647-8111
(706) 647-4389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
022458
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
708309
BLUE CROSS BLUE SHIELD
—
01
—
P00160614
RAILROAD MEDICARE
—
Enumeration date
08/26/2005
Last updated
07/08/2007
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