Healthcare Provider Details

I. General information

NPI: 1366952707
Provider Name (Legal Business Name): CHELSIE ROGERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 E PACES FERRY RD NE STE 825
ATLANTA GA
30305-3292
US

IV. Provider business mailing address

371 E PACES FERRY RD NE STE 825
ATLANTA GA
30305-3292
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-4110
  • Fax: 404-252-2188
Mailing address:
  • Phone: 404-314-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26888
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number78424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: