MEDICARE: MRS. REGINA T ROGERS APRN

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	363LF0000X	Family Nurse Practitioner	RN144953NP	GA

General Provider Information

NPI Number	:	1093879264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA T ROGERS APRN

Provider Business Mailing Address
First Line	:	265 CHANDLERS RIDGE
Second Line	:
City	:	CHATSWORTH
State	:	GA
Zip	:	30705-6436
Country	:	US
Telephone Number	:	706-876-2130
Fax Number	:	706-876-2168

Provider Business Practice Location Address
First Line	:	1575 CHATTANOOGA AVE
Second Line	:	STE 1
City	:	DALTON
State	:	GA
Zip	:	30720-2671
Country	:	US
Telephone Number	:	706-876-2130
Fax Number	:	706-876-2168

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/19/2011

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