Individual
FANESHIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4475 W VILLAGE PKWY, ELLENWOOD, GA 30294-2869
(770) 507-7950
Mailing address
289 JONESBORO RD STE 104, MCDONOUGH, GA 30253-3725
(470) 641-5996
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
259066
GA
363LF0000X
Family Nurse Practitioner
Primary
APRN-NP259066
GA
Other
Enumeration date
01/11/2021
Last updated
11/01/2025
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