Individual
BERRY LAWRENCE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPNP
Contact information
Practice address
1405 CLIFTON RD NE, SECOND FLOOR CSW, ATLANTA, GA 30322
(404) 785-1587
(404) 785-1872
Mailing address
105 NORMANDY DRIVE, FAYETTEVILLE, GA 30214
(770) 719-2005
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
113166
GA
Other
Enumeration date
05/17/2006
Last updated
10/31/2011
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