Healthcare Provider Details

I. General information

NPI: 1871822361
Provider Name (Legal Business Name): ROBERT CURT PETERSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 WARM SPRINGS RD STE C
COLUMBUS GA
31909-6938
US

IV. Provider business mailing address

5041 WARM SPRINGS RD STE C
COLUMBUS GA
31909-6938
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-2448
  • Fax: 706-221-2338
Mailing address:
  • Phone: 706-221-2448
  • Fax: 706-221-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1579
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: