PETERSON DERMATOLOGY, P.C.
NPI 1932300886
Dermatology in Vidalia, GA
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
Specialties & Licenses 3
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Peterson Dermatology, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Peterson Dermatology, P.C., which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, GAFrequently 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.
Is Peterson Dermatology, P.C. enrolled in Medicare?
Yes. Peterson Dermatology, P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Peterson Dermatology, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Peterson Dermatology, P.C., in Dermatology, General Surgery and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
# Peterson Dermatology, P.c. · NPI 1932300886
Dermatology organization in Vidalia, Georgia. Organization record, active in the CMS NPPES registry since May 29, 2007.
## Identity
- **NPI:** 1932300886 (Entity type: Organization)
- **Enumerated:** May 29, 2007
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Letty Peterson, DERMATOLOGIST
## Practice location
- **Address:** 305 W 1ST ST, Vidalia, GA 30474-3302
- **Phone:** (912) 538-9080 · **Fax:** (912) 538-9085
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (1), General Surgery (1), Nurse Practitioner (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 20, 2013
- **Other identifiers:** Medicare PIN GRP8091 (GA); Medicaid 551383524A (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1932300886) · Data from the CMS NPPES public registry.