Active NPI
Alan Clark Peterson Sr., D.M.D.
- Public Health Dentistry
- Atlanta, GA
National Provider Identifier
1174975429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 015796
- Practice address
- 601 McDonough Blvd SE
Atlanta, GA 30315-4400 - Phone
- (404) 635-5462
- NPI assigned
- Jul 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 015796 | MO | Primary |
Addresses
Primary practice location
601 McDonough Blvd SE
Atlanta, GA 30315-4400
Mailing address
601 McDonough Blvd SE
Atlanta, GA 30315-4400
Phone (404) 635-5462
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015796 | MO | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468195200000",
"number": "1174975429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 MCDONOUGH BLVD SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303154400",
"telephone_number": "404-635-5462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 MCDONOUGH BLVD SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303154400",
"telephone_number": "404-635-5462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ALAN",
"middle_name": "CLARK",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-11",
"last_updated": "2016-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "MO",
"license": "015796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.