Carl Frederick Peterson Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DS 8378 Issued in GA

Practice address

1200 McFarland Ave
Rossville, GA 30741-2312

Phone

(706) 861-1828

Fax

(706) 861-1936

NPI assigned

Dec 15, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sunrise Dental Associates, LLC

  • Dental Clinic/Center
  • Rossville, GA
  • NPI 1891661849
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386706448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MCFARLAND AVE",
            "city": "ROSSVILLE",
            "state": "GA",
            "postal_code": "307412312",
            "telephone_number": "706-861-1828",
            "fax_number": "706-861-1936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MCFARLAND AVE",
            "city": "ROSSVILLE",
            "state": "GA",
            "postal_code": "307412312",
            "telephone_number": "706-861-1828",
            "fax_number": "706-861-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CARL",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DS 8378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000061685A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parkside Operation LLC (The Center for Advanced Rehab at Parkside)
• Passion4People Healthcare Advocacy & Navigation Services LLC
• Pedro Juan Perez Jr., DMD
• Perfect Start ABA
• Kimberly Elaine Perra, PTA
• Aimee Pierce, LPC
• David Poehlein, CADCII
• Kathleen Marie Powell, PT
• Primary Health Care Center of Dade, Inc. (Primary Health Care at Rossville Elementary SBHC)
• Primary Health Care Center of Dade, Inc. (Primary Health Care Rossville Middle School SBHC)

• Dentist in Rossville, GA
• Providers in Rossville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.