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General NPI Number Information
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NPI Number | 1740929306
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Entity Type | Individual
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Provider Name | RYAN ROGERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 17007 HIGHWAY 67
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City | STATESBORO
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State | GA
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Zip | 30458-2426
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Country | US
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Telephone | 912-681-2500
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Fax | 912-681-2025
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Provider Business Mailing Address
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Address Line | 210 E DERENNE AVE
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City | SAVANNAH
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State | GA
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Zip | 31405-6736
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Country | US
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Telephone | 912-644-5300
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Fax | 912-644-5241
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11904
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11904
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License Number State | GA
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