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PETERSON DERMATOLOGY, P.C.
NPI 1932300886
Dermatology in Vidalia, GA

Active since May 29, 2007CLIA 11D1073390 · Certificate of Compliance
305 W 1ST ST, VIDALIA, GA 30474(912) 538-9080(912) 538-9085 Get Directions Write a Review

NPPES record last updated: September 20, 2013. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Peterson Dermatology, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PETERSON DERMATOLOGY, P.C. (NPI 1932300886) is a healthcare organization registered as a dermatology in Vidalia, Georgia and active in the NPI registry since May 2007. The organization holds a CLIA Certificate of Compliance certificate valid through December 14, 2026 and lists Letty Revell Peterson, Dermatologist, as its authorized official.

NPPES Registry Identity

NPI1932300886
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePETERSON DERMATOLOGY, P.C.
Location Address305 W 1ST STVidalia, GA 30474-3302
Mailing Address305 W 1st StVidalia, GA 30474-3302 · (912) 538-9080 · Fax (912) 538-9085
Phone(912) 538-9080
Fax(912) 538-9085
Organization SubpartNo
Authorized OfficialLetty Revell PetersonDermatologist · (912) 538-9080
Enumeration DateMay 29, 2007
Last NPPES UpdateSeptember 20, 2013
✔ NPI 1932300886 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in GA · 058913
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · Pediatric DermatologyTaxonomy 207NP0225X · License 058913 (GA)
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License 058913 (GA)
305 W 1ST ST, Vidalia, GA 30474
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Other Identifiers 2

Medicare PINGRP8091GA
Medicaid551383524AGA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 11D1073390

Peterson Dermatology · Vidalia, GA
Active · expires Dec 14, 2026
CLIA Number11D1073390
Laboratory TypePhysician Office
Certificate Effective DateDecember 15, 2024
Certificate Expiration DateDecember 14, 2026
Laboratory DirectorLetty R. Peterson
Laboratory Phone(912) 538-9080
Laboratory LocationPeterson Dermatology305 First Street West, Vidalia, GA 30474
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WALTER J REVELL JR. MD
Surgery
305 W 1ST ST
VIDALIA, GA 30474
Toombs County (912) 538-9080

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Peterson Dermatology, P.C.'s NPI number?

The NPI number for Peterson Dermatology, P.C. is 1932300886. It was assigned to this organization in the NPPES registry on May 29, 2007.

Where is Peterson Dermatology, P.C. located?

Peterson Dermatology, P.C. is located at 305 W 1st St, Vidalia, GA 30474. The listed phone number is (912) 538-9080.

What is Peterson Dermatology, P.C.'s specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Peterson Dermatology, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 11D1073390) is associated with this NPI, valid through December 14, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Peterson Dermatology, P.C. accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Peterson Dermatology, P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Peterson Dermatology, P.C. was last updated on September 20, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.