Individual
JACK A. ROGERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 PLANTATION AVE, CEDARTOWN, GA 30125-2370
(678) 901-0717
(678) 901-0718
Mailing address
114 PLANTATION AVE, CEDARTOWN, GA 30125-2370
(678) 901-0717
(678) 901-0718
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
GA 017875
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
625778716B
—
GA
Enumeration date
07/11/2005
Last updated
12/01/2011
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