Healthcare Provider Details

I. General information

NPI: 1659285153
Provider Name (Legal Business Name): HEATHER MARIE ROGERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 ROME BLVD
SUMMERVILLE GA
30747-1629
US

IV. Provider business mailing address

9777 ROME BLVD
SUMMERVILLE GA
30747-1629
US

V. Phone/Fax

Practice location:
  • Phone: 706-368-8899
  • Fax:
Mailing address:
  • Phone: 706-368-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP005618
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: