Provider Demographics
NPI:1891016887
Name:PEOTTER, PATRICIA A (MT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PEOTTER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:PEOTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:9950 JONES BRIDGE RD
Mailing Address - Street 2:SUITE #600
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6574
Mailing Address - Country:US
Mailing Address - Phone:770-734-0037
Mailing Address - Fax:
Practice Address - Street 1:9950 JONES BRIDGE RD
Practice Address - Street 2:SUITE #600
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6574
Practice Address - Country:US
Practice Address - Phone:770-734-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist