Provider Demographics
NPI:1518900018
Name:WAY, PETER J (NP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:WAY
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:300 HOSPITAL ROAD
Mailing Address - Street 2:6TH FLOOR INTERDISCIPLINARY PAIN MANAGEMENT CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-8322
Mailing Address - Fax:706-787-0196
Practice Address - Street 1:300 HOSPITAL ROAD
Practice Address - Street 2:6TH FLOOR INTERDISCIPLINARY PAIN MANAGEMENT CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-8322
Practice Address - Fax:706-787-0196
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-05-04
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Provider Licenses
StateLicense IDTaxonomies
NC200929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA837076974AMedicaid
SCNP0984Medicaid
GAS91999Medicare UPIN