Provider Demographics
NPI:1093784977
Name:NUNN, ROGER EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:EUGENE
Last Name:NUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 ALLENDALE FAIRFAX HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827-9133
Mailing Address - Country:US
Mailing Address - Phone:803-632-3421
Mailing Address - Fax:803-632-2410
Practice Address - Street 1:1787 ALLENDALE FAIRFAX HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:SC
Practice Address - Zip Code:29827-9133
Practice Address - Country:US
Practice Address - Phone:803-632-3421
Practice Address - Fax:803-632-2410
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine