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General NPI Number Information
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NPI Number | 1508916503
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Entity Type | Individual
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Provider Name | JUDI TAYLOR ROGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 100 MARINERS DR STE D
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City | KINGSLAND
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State | GA
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Zip | 31548-6667
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Country | US
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Telephone | 770-656-4401
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Fax | 386-283-4170
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Provider Business Mailing Address
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Address Line | 90 SAN JUAN DR APT B104
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City | PALM COAST
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State | FL
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Zip | 32137-2368
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Country | US
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Telephone | 770-331-9344
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Fax | 386-283-4170
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW002516
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License Number State | GA
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