Healthcare Provider Details

I. General information

NPI: 1295822971
Provider Name (Legal Business Name): ROSEMARY ROBERTSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 3020 SAND HILL
FT. BENNING GA
31905
US

IV. Provider business mailing address

4842 YOSEMITE DR
COLUMBUS GA
31907-1754
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-8987
  • Fax:
Mailing address:
  • Phone: 706-544-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002795
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: