Provider Demographics
NPI:1184677098
Name:POSSERT, PETER WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:POSSERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 PROFESSIONAL CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2531
Mailing Address - Country:US
Mailing Address - Phone:770-907-0554
Mailing Address - Fax:
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE T10
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8017
Practice Address - Country:US
Practice Address - Phone:770-721-9000
Practice Address - Fax:770-721-9001
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0498642085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG27415Medicare UPIN