Individual
ROBERT ALAN PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1505 PROFESSIONAL CT, DALTON, GA 30720-2500
(706) 275-6121
Mailing address
1505 PROFESSIONAL CT, DALTON, GA 30720-2500
(706) 275-6121
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
021783
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000200307D
—
GA
01
—
406133349
MEDICARE RAILROAD
GA
Enumeration date
01/24/2006
Last updated
07/24/2008
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