Healthcare Provider Details

I. General information

NPI: 1154141430
Provider Name (Legal Business Name): DORTHEA YOLANDA ROGERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GOVERNORS SQ STE B
PEACHTREE CITY GA
30269-4871
US

IV. Provider business mailing address

865 WAGON WHEEL CIR
FAYETTEVILLE GA
30214-9622
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-5500
  • Fax: 678-271-3204
Mailing address:
  • Phone: 470-856-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN311743
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: