Peterson, Letty Revell
Peterson, Letty Revell is an sole proprietor health care provider with primary practice located at 305 First St. West , Vidalia GA 30474-7201. She recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Peterson, Letty Revell can be contacted via phone (912) 538-9080.Contact Information
Primary practice address
305 First St. West
Vidalia GA 30474-7201
Phone: (912) 538-9080
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 058913 | Georgia |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 058913 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | 058913 | Georgia |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 058913 | Georgia |
Profile Details
| NPI number | 1760507974 |
|---|---|
| LBN Legal business name | Peterson, Letty Revell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 20th, 2007 |
| Last updated | Oct 22nd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760507974 | NPPES |
| Georgia | MEDICAID | 551383524A |
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