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General NPI Number Information
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NPI Number | 1285846774
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Entity Type | Organization
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Legal Business Name | DEBRA E RODGERS MD PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 175 OLYMPIA FLDS
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City | JACKSON
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State | MS
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Zip | 39211-2510
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Country | US
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Telephone | 601-956-7805
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Fax | 601-956-7805
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Provider Business Mailing Address
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Address Line | 175 OLYMPIA FLDS
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City | JACKSON
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State | MS
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Zip | 39211-2510
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Country | US
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Telephone | 601-956-7805
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Fax | 601-056-7805
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBRA E RODGERS
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Credential | M.D.
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Telephone | 601-956-7805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 08039
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License Number State | MS
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