Provider Demographics
NPI:1629246038
Name:PETERS, CHANYA M (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHANYA
Middle Name:M
Last Name:PETERS
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Gender:F
Credentials:APRN-BC
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Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:488 KENNESAW AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9409
Practice Address - Country:US
Practice Address - Phone:770-427-3075
Practice Address - Fax:770-427-3261
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2014-06-06
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Provider Licenses
StateLicense IDTaxonomies
TN137603163WG0100X
TN11839363L00000X
TNAPN0000011839363L00000X
GARN237921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology