Provider Demographics
NPI:1831362037
Name:PETERS, WALTER HAMILTON IV (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:HAMILTON
Last Name:PETERS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAMILTON
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:8 RICHLAND MEDICAL PARK
Practice Address - Street 2:SUITE 420
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8004
Practice Address - Country:US
Practice Address - Phone:803-545-6050
Practice Address - Fax:803-545-6051
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC392072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC392079Medicaid
SCSC86079482Medicare PIN
SCSC8607F935Medicare PIN