Peterson, Matthew Shane

Peterson, Matthew Shane is an individual health care provider with primary practice located at 750 Townpark Ln Nw , Kennesaw GA 30144-5579. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Peterson, Matthew Shane can be contacted via phone (404) 365-0966.

Contact Information

Primary practice address
750 Townpark Ln Nw Kennesaw GA 30144-5579
Phone: (404) 365-0966
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 200200772 North Carolina
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 85640 Georgia

Profile Details

NPI number 1255319828
LBN Legal business name Peterson, Matthew Shane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2006
Last updated Jan 22nd, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255319828 NPPES
North Carolina MEDICAID 89132R9

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