MEDICARE: PROMISES ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	.	VA

General Provider Information

NPI Number	:	1043862147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROMISES ROGERS

Provider Business Mailing Address
First Line	:	4280 PIEDMONT PKWY STE 105
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 PIEDMONT PKWY STE 105
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8159
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	04/14/2026

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