Provider Demographics
NPI:1912990391
Name:FUTRELL, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NORTHSIDE FORSYTH DR STE 440
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6015
Mailing Address - Country:US
Mailing Address - Phone:770-203-4881
Mailing Address - Fax:470-839-2435
Practice Address - Street 1:1100 NORTHSIDE FORSYTH DR STE 440
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6015
Practice Address - Country:US
Practice Address - Phone:770-203-4881
Practice Address - Fax:470-839-2435
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0412962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG81326Medicare UPIN
GA39BDBZRMedicare PIN