Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. LETTY REVELL PETERSON, M.D.
Active Sole ProprietorDR. LETTY REVELL PETERSON, M.D. is a Dermatology healthcare provider located in VIDALIA, Georgia. NPI 1760507974 is currently active in the NPPES registry. Verify at CMS.
Dermatology · VIDALIA, GA
Registration Details
- NPI Number
- 1760507974
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Mar 20, 2007 (19.430990863567 yrs)
- Last Updated
- Oct 22, 2012
- Licenses
-
058913 (GA)058913 (GA)058913 (GA)058913 (GA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
305 FIRST ST. WESTVIDALIA, GA, 304747201Browse GA providers · Browse ZIP 30474
- Phone
- 9125389080
- Primary Specialty
-
Dermatology
207N00000X
- Additional Specialty
- Obesity Medicine
- Additional Specialty
- 207NP0225X
- Additional Specialty
- Procedural Dermatology
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.