Healthcare Provider Details

I. General information

NPI: 1912950775
Provider Name (Legal Business Name): ROGERS DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3B CLEVELAND CT
GREENVILLE SC
29607-2414
US

IV. Provider business mailing address

3B CLEVELAND CT
GREENVILLE SC
29607-2414
US

V. Phone/Fax

Practice location:
  • Phone: 864-351-0332
  • Fax: 864-351-0373
Mailing address:
  • Phone: 864-351-0332
  • Fax: 864-351-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number6924
License Number StateSC

VIII. Authorized Official

Name: NINA C GODFREY
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-351-0332