Individual
SUSAN C. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-AA
Contact information
Practice address
303 PARKWAY DRIVE NE,, PMB 404, ATLANTA, GA 30312-1212
(404) 265-4520
(404) 265-3894
Mailing address
PO BOX 932925, ATLANTA, GA 31193-2925
(800) 364-9216
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
PA005691
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393102621A
—
GA
05
—
393102621B
—
GA
Enumeration date
11/06/2009
Last updated
03/18/2021
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