Healthcare Provider Details

I. General information

NPI: 1871611293
Provider Name (Legal Business Name): ERICA STICH ROGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 N MAIN ST SUITE B
SHELBYVILLE TN
37160-2391
US

IV. Provider business mailing address

880 COLLOREDO BLVD
SHELBYVILLE TN
37160-2774
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-2022
  • Fax: 931-492-4355
Mailing address:
  • Phone: 931-685-8111
  • Fax: 931-685-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: