Individual
JEFFREY JUSTIN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 JOHNSON FERRY RD, ATLANTA, GA 30342
(404) 851-6323
(404) 303-3747
Mailing address
5605 GLENRIDGE DR STE 325, ATLANTA, GA 30342-1365
(678) 553-7783
(678) 553-7793
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
066883
GA
2085R0202X
Diagnostic Radiology Physician
47555
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0592113
—
IA
01
—
135108
UCARE
MN
01
—
16-03566
MEDICA
MN
01
—
171P6PE
BLUE CROSS/BLUE SHIELD OF MN
MN
01
—
1935877
AMERICA'S PPO
MN
05
—
34649100
—
WI
05
—
390400800
—
MN
01
—
9249279
DAKOTA CARE
MN
01
—
HP52064
HEALTHPARTNERS
MN
01
—
P00252409
RAILROAD MEDICARE
MN
01
—
P00285261
RAILROAD MEDICARE
WI
Enumeration date
05/06/2006
Last updated
05/06/2019
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