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Individual

MR. ROGER EDWARD PIERCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
380 HOSPITAL DR, SUITE 410, MACON, GA 31217
(478) 746-5644
Mailing address
PO BOX 2564, MACON, GA 31203-2565
(478) 746-5644
(478) 745-4849

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN140913
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003120764A
GA
05
003120764B
GA
05
003120764C
GA
05
003120764D
GA
01
01777930
AMERIGROUP
GA
01
580628385
TRICARE
GA
01
654921
WELLCARE
GA
01
P01052567
RAILROAD MEDICARE
GA
Enumeration date
02/02/2012
Last updated
06/04/2013
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