Provider Demographics
NPI:1154442994
Name:PETERS, NICHOLAS DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVID
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 BRANHAM CIR
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-2911
Mailing Address - Country:US
Mailing Address - Phone:770-464-0388
Mailing Address - Fax:
Practice Address - Street 1:3215 HIGHWAY 278 NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2202
Practice Address - Country:US
Practice Address - Phone:770-786-1131
Practice Address - Fax:770-786-6727
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist