Individual
ROGER DAVID MASTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
80 NEWNAN STATION DR, SUITE A, NEWNAN, GA 30265-5209
(770) 251-2060
(678) 854-9235
Mailing address
PO BOX 73709, NEWNAN, GA 30271-3709
(478) 714-7812
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
CRNA01013
NM
367500000X
Certified Registered Nurse Anesthetist
Primary
RN062574
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00547137C
—
GA
01
—
430076996
MCRB RR
GA
Enumeration date
02/23/2006
Last updated
04/27/2015
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