Healthcare Provider Details

I. General information

NPI: 1073422507
Provider Name (Legal Business Name): ALEXIS DEANN ROGERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 STEWART PKWY
DOUGLASVILLE GA
30135-2371
US

IV. Provider business mailing address

1816 MORNING GLORY LN NE
ATLANTA GA
30324-4284
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-5575
  • Fax: 470-539-8557
Mailing address:
  • Phone: 678-361-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP290712
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: