Individual
PHILLIP DALE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
536 NORVILLE DR NW, RESACA, GA 30735-6174
(706) 280-3991
Mailing address
536 NORVILLE DR NW, RESACA, GA 30735-6174
(706) 280-3991
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
GA
Other
Enumeration date
02/21/2018
Last updated
02/21/2018
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