Provider Demographics
NPI:1952910994
Name:PETERSON, MARGARET GRACE (RD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GRACE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5193 PEACHTREE BLVD APT 1402
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2858
Mailing Address - Country:US
Mailing Address - Phone:770-356-0279
Mailing Address - Fax:
Practice Address - Street 1:5193 PEACHTREE BLVD APT 1402
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2858
Practice Address - Country:US
Practice Address - Phone:770-356-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered