Healthcare Provider Details

I. General information

NPI: 1124612437
Provider Name (Legal Business Name): GLORIA RODGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 FULTON RD STE 107
CLEVELAND OH
44109-1466
US

IV. Provider business mailing address

1445 WOODMONT LN NW STE 3334
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 762-323-1414
  • Fax:
Mailing address:
  • Phone: 762-323-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: