Letty Revell Peterson in Vidalia - Procedural Dermatology
Letty Revell Peterson - NPI 1760507974
Letty Revell Peterson is a Procedural Dermatology in Vidalia, Georgia. Letty Revell Peterson practices all healthcare services and medical treatments related to Procedural Dermatology. The NPI Number for Letty Revell Peterson is 1760507974. The last update date is 2012-10-22.
Letty Revell Peterson's current location address is 305 First St. West, Vidalia, Georgia. You can contact this provider via phone number 9125389080. The mailing address for Letty Revell Peterson is 305 First St. West, Vidalia, Georgia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Letty Revell Peterson |
|---|---|
| Address | 305 First St. West, Vidalia, Georgia |
| Phone Number | 9125389080 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1760507974 |
|---|---|
| Provider Enumeration Date | 2007-03-20 |
| Last Updated Date | 2012-10-22 |
Provider Mailing Address Detail
| Address | 305 First St. West |
|---|---|
| City | Vidalia |
| State | Georgia (GA) |
| Post Code | 304747201 |
| Phone Number | 9125389080 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Procedural Dermatology |
|---|---|
| Taxonomy | 207Ns0135X |
| Licence No | 58913 |
|
Definition: Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surge |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 551383524A | GA | -- |
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What is the unique provider identifier assigned to Letty Revell Peterson?
The Letty Revell Peterson has been issued the NPI (National Provider Identifier) 1760507974 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Can you provide the Letty Revell Peterson's physical address?
The Letty Revell Peterson is physically located at 305 First St. West, in the city of Vidalia, GA, with the postal code 304747201.
What is Letty Revell Peterson's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Letty Revell Peterson's specialized field of practice is Procedural Dermatology, and the corresponding taxonomy code that categorizes this area of specialization is 207Ns0135X.
On what date did Letty Revell Peterson receive its 1760507974 assignment from the Centers for Medicare & Medicaid Services?
The Letty Revell Peterson was assigned its 1760507974 on 2007-03-20, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details pertaining to Letty Revell Peterson last refreshed?
The information related to the Letty Revell Peterson, including its address, specialty, and other relevant details, was last updated on 2012-10-22.
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