Healthcare Provider Details

I. General information

NPI: 1285846774
Provider Name (Legal Business Name): DEBRA E RODGERS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 OLYMPIA FLDS
JACKSON MS
39211-2510
US

IV. Provider business mailing address

175 OLYMPIA FLDS
JACKSON MS
39211-2510
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-7805
  • Fax: 601-956-7805
Mailing address:
  • Phone: 601-956-7805
  • Fax: 601-056-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number08039
License Number StateMS

VIII. Authorized Official

Name: DR. DEBRA E RODGERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-956-7805