Provider Demographics
NPI:1992708424
Name:ROGERS, JOHN KITCHENER (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KITCHENER
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GEORGETOWN CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-3076
Mailing Address - Country:US
Mailing Address - Phone:478-471-6672
Mailing Address - Fax:
Practice Address - Street 1:110 GEORGETOWN CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-3076
Practice Address - Country:US
Practice Address - Phone:478-471-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095473 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005470Z7DMedicaid
GA0005470Z7DMedicaid