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General NPI Number Information
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NPI Number | 1225174055
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Entity Type | Individual
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Provider Name | DENINE MARION ROGERS RD LD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1075 WALKER PLACE DRIVE
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 678-952-9881
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Fax | 770-693-1185
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Provider Business Mailing Address
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Address Line | 1075 WALKER PLACE DRIVE
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 678-952-9881
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Fax | 770-693-1185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD001969
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License Number State | GA
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