Provider Demographics
NPI:1235325895
Name:ROGERS, DINISHA C (RD,LD)
Entity Type:Individual
Prefix:
First Name:DINISHA
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-0897
Mailing Address - Country:US
Mailing Address - Phone:678-442-6884
Mailing Address - Fax:770-339-4297
Practice Address - Street 1:8203 HAZELBRAND RD NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1510
Practice Address - Country:US
Practice Address - Phone:770-786-9086
Practice Address - Fax:770-786-0715
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered