Provider Demographics
NPI:1063511673
Name:BESSEY, ROGER BRUCE (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:BRUCE
Last Name:BESSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NORTHSIDE FORSYTH DRIVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-888-8888
Mailing Address - Fax:770-888-4502
Practice Address - Street 1:1100 NORTHSIDE FORSYTH DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-888-8888
Practice Address - Fax:770-888-4502
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA026063OtherSTATE LICENSE
O40645Medicare UPIN