MEDICARE: DR. ROBERT CURT PETERSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	1579	AL
2	103TC1900X	Counseling Psychologist	PSY003322	GA

General Provider Information

NPI Number	:	1871822361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CURT PETERSON PH.D.

Provider Business Mailing Address
First Line	:	5041 WARM SPRINGS RD STE C
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6938
Country	:	US
Telephone Number	:	706-221-2448
Fax Number	:	706-221-2338

Provider Business Practice Location Address
First Line	:	5041 WARM SPRINGS RD STE C
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6938
Country	:	US
Telephone Number	:	706-221-2448
Fax Number	:	706-221-2338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	11/03/2011

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