Provider Demographics
NPI:1164547683
Name:PETERSON, EUNICE RAGLAND (MD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:RAGLAND
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MCGEE RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2104
Mailing Address - Country:US
Mailing Address - Phone:864-260-2220
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-8431
Practice Address - Fax:864-455-8981
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC342222084P0800X, 2084P0804X
TXS35662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01089395OtherRAILROAD MEDICARE
SC342221Medicaid
SCAA80217951Medicare PIN