Provider Demographics
NPI:1316354376
Name:ROGERS, YVONNE M
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 DELOWE DR
Mailing Address - Street 2:P.O. BOX 90085
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2344
Mailing Address - Country:US
Mailing Address - Phone:678-283-2897
Mailing Address - Fax:404-767-5466
Practice Address - Street 1:2587 DELOWE DR
Practice Address - Street 2:2587 DELOWE DRIVE
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2344
Practice Address - Country:US
Practice Address - Phone:678-283-2897
Practice Address - Fax:404-767-5466
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051469739172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver