Michael Petrosky, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

030855 Issued in GA

Practice address

120 Vann St NE
Ste 150
Marietta, GA 30060-7250

Phone

(770) 421-1242

Fax

(770) 424-6652

NPI assigned

Aug 31, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1164416582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 VANN ST NE",
            "address_2": "STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607250",
            "telephone_number": "770-421-1242",
            "fax_number": "770-424-6652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 VANN ST NE",
            "address_2": "STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607250",
            "telephone_number": "770-421-1242",
            "fax_number": "770-424-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSKY",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "GA",
            "license": "030855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER TRANSACTION ACCESS NUMBER-PTAN",
            "identifier": "24BCBBD",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emilie Peterson, RBT
• Joy Henning Peterson, PHARM.D.
• Sierra Peterson
• Cynthia Petrella, APRN
• Karen Marise Petrella, DDS
• Douglas B Pettit, DC
• Jonathan David Pewitt, M.D.
• Aidiem Pham
• Loc B Pham, MD
• Robert V Pham, MD

• Plastic and Reconstructive Surgery Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Plastic and Reconstructive Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.