Provider Demographics
NPI:1275716938
Name:ROGERS, CLAIRE PRICE (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:PRICE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:CLAIRE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8668
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:
Practice Address - Street 1:103 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1419
Practice Address - Country:US
Practice Address - Phone:706-235-7711
Practice Address - Fax:706-235-9944
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ58319Medicare UPIN