Healthcare Provider Details

I. General information

NPI: 1033193099
Provider Name (Legal Business Name): PETER BECHAN ROSENQUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 SAINT SEBASTIAN WAY GEORGIA REGENTS MEDICAL ASSOCIATES
AUGUSTA GA
30901
US

IV. Provider business mailing address

1499 WALTON WAY, SUITE 1400 ATTN: DONNA RAIFORD
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6597
  • Fax:
Mailing address:
  • Phone: 706-828-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number068296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: