Individual
TAWANNA DENISE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 HARTLEY ST, FORT VALLEY, GA 31030-4477
(478) 391-4906
Mailing address
113 HARTLEY ST, FORT VALLEY, GA 31030-4477
(478) 391-4906
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN054487
GA
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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