Healthcare Provider Details

I. General information

NPI: 1336636067
Provider Name (Legal Business Name): AERYN ELISE ROGERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELIJAH ROGERS

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4505
US

IV. Provider business mailing address

504 CLINTON CENTER DR STE 4300
CLINTON MS
39056-5610
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-1779
  • Fax: 601-815-0444
Mailing address:
  • Phone: 601-815-2005
  • Fax: 601-815-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31336
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: