Provider Demographics
NPI:1679577324
Name:PETERSON, EDWARD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANDREW
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:341 COOL SPRINGS BLVD.
Mailing Address - Street 2:STE. 400
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:423-508-7337
Mailing Address - Fax:423-508-7338
Practice Address - Street 1:7268 JARNIGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3097
Practice Address - Country:US
Practice Address - Phone:423-508-7337
Practice Address - Fax:423-508-7338
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052293207W00000X
KY35448207W00000X
TNMD-37052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6156Medicaid
TN3721447Medicaid
TN3721447Medicaid
TNH64064Medicare UPIN
TN3721447Medicaid