Provider Demographics
NPI:1528068046
Name:ROGERS, BENJAMIN C (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B
Other - Middle Name:CARTER
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4181 HOSPITAL DR NE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-787-6957
Mailing Address - Fax:770-784-0381
Practice Address - Street 1:4181 HOSPITAL DR NE
Practice Address - Street 2:SUITE 303
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-787-6957
Practice Address - Fax:770-784-0381
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00705526CMedicaid