Provider Demographics
NPI:1558675264
Name:PETERKIN AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PETERKIN AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:404-228-4548
Mailing Address - Street 1:2692 HARRIS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2672
Mailing Address - Country:US
Mailing Address - Phone:404-228-4548
Mailing Address - Fax:404-228-4597
Practice Address - Street 1:2692 HARRIS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2672
Practice Address - Country:US
Practice Address - Phone:404-228-4548
Practice Address - Fax:404-228-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health