Peterson Dermatology, P.C.
LBN: Peterson Dermatology, P.C.
Peterson Dermatology, P.C. is an health care organization with primary practice located at 305 W 1St St , Vidalia GA 30474-3302. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Dermatology is the primary health care specialty.
Peterson Dermatology, P.C. can be contacted via phone (912) 538-9080, or through Peterson, Letty Revell via phone (912) 538-9080.
Contact Information
Primary practice address
305 W 1St St
Vidalia GA 30474-3302
Phone: (912) 538-9080
Fax: (912) 538-9085
Website:
Authorized official contact:
Name: Peterson, Letty Revell Doctor of Medicine (MD)
Phone: (912) 538-9080
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 058913 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | 058913 | Georgia |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 058913 | Georgia |
Profile Details
| NPI number | 1932300886 |
|---|---|
| LBN Legal business name | Peterson Dermatology, P.C. |
| DBA Doing business as | |
| Authorized official | Peterson, Letty Revell Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 29th, 2007 |
| Last updated | Sep 20th, 2013 - about 12 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932300886 | NPPES |
| Georgia | MEDICAID | 551383524A |
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