Provider Demographics
NPI:1962736520
Name:ROGERS, DONNA (LMT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 LOBLOLLY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-3012
Mailing Address - Country:US
Mailing Address - Phone:404-405-0346
Mailing Address - Fax:404-298-0789
Practice Address - Street 1:5335 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6753
Practice Address - Country:US
Practice Address - Phone:404-405-0346
Practice Address - Fax:404-298-0789
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29665400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist