Provider Demographics
NPI:1114901873
Name:PETERMAN, SOPHIA BROTHERS (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:BROTHERS
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:BROTHERS
Other - Last Name:PETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:487 BURLINGTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1103
Mailing Address - Country:US
Mailing Address - Phone:404-676-0482
Mailing Address - Fax:404-378-1843
Practice Address - Street 1:487 BURLINGTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1103
Practice Address - Country:US
Practice Address - Phone:404-667-0482
Practice Address - Fax:404-378-1843
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0269132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3000122061OtherRAILROAD MEDICARE
GAP00096724OtherRIALROAD MEDICARE
GA300122060OtherRAILROAD MEDICARE
GA000925086FMedicaid
GA202G708830OtherRAILROAD MEDICARE
GA000369465NMedicaid
GA202G708830OtherRAILROAD MEDICARE
GA300122060OtherRAILROAD MEDICARE
GA000925086FMedicaid