Healthcare Provider Details

I. General information

NPI: 1609924349
Provider Name (Legal Business Name): INGER K ROUG D.C,D.A.C.B.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 YORKSHIRE CT
WOODSTOCK GA
30189-5223
US

IV. Provider business mailing address

2122 YORKSHIRE CT
WOODSTOCK GA
30189-5223
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-1484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCHIR005939
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: