Provider Demographics
NPI:1689341182
Name:PETERS, WILLIAM DAVID (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:PETERS
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1331 CAMERON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3046
Mailing Address - Country:US
Mailing Address - Phone:917-821-6859
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0004
Practice Address - Country:US
Practice Address - Phone:404-778-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250386367500000X
TN30248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered