Organization
KRISTIANSSON ROTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTIANSSON ROTH PHD (DOCTOR)
(912) 409-9879
Entity
Organization
Contact information
Practice address
4445 HWY 40, SATURDAY PARK 503, SAINT MARYS, GA 31558-4099
(912) 409-9879
Mailing address
4445 HWY 40, SATURDAY PARK 503, SAINT MARYS, GA 31558-4099
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002706
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118222317B
—
GA
Enumeration date
09/11/2009
Last updated
09/11/2009
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