MEDICARE: ERIC JERMAINE ROGERS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295614477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JERMAINE ROGERS BCBA

Provider Business Mailing Address
First Line	:	131 VILLAGE PKWY NE BLDG 4
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4061
Country	:	US
Telephone Number	:	470-787-2242
Fax Number	:	470-787-2104

Provider Business Practice Location Address
First Line	:	131 VILLAGE PKWY NE BLDG 4
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4061
Country	:	US
Telephone Number	:	470-992-3607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	01/10/2026

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