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Individual

ANDRE PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2855 SUWANEE LAWRENCEVILLE RD, SUWANEE, GA 30024-3563
(770) 394-9055
Mailing address
2058 AMBER TRL, DULUTH, GA 30096-4935
(917) 549-6511

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
098977
NY

Other

Enumeration date
10/18/2021
Last updated
10/18/2021
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