Provider Demographics
NPI:1740252386
Name:PETERS, VALERIE L (MS, RD, LD)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,RDLD
Mailing Address - Street 1:227 RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3717
Mailing Address - Country:US
Mailing Address - Phone:478-274-9553
Mailing Address - Fax:
Practice Address - Street 1:227 RIDGE CIR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3717
Practice Address - Country:US
Practice Address - Phone:478-274-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2121133V00000X
FLND001100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5111710036OtherMEDICARE PTAN