OrganizationActive
363l00000x
NPI 1760856645 · Nursing Facility/Intermediate Care Facility · Atlanta, GA
Provider details
- NPI number
- 1760856645
- Entity type
- Organization
- Primary specialty
- Nursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Anetha Peterson, Nurse Practitioner
- License
- 363L00000X (GA)
Practice location
2171 Peachtree Rd Ne
Apt 306
Atlanta, GA 30309-6300
Phone: (678) 464-9424
Mailing address
2171 Peachtree Rd Ne
Atlanta, GA 30309-6300
Registry dates
- Enumerated
- 2015-11-16
- Last updated
- 2015-11-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.