Provider Demographics
NPI:1376686527
Name:ROGERS, TYRONE WILLIAM (CSA)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:WILLIAM
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:PO BOX 1875
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-1875
Mailing Address - Country:US
Mailing Address - Phone:678-516-8905
Mailing Address - Fax:678-455-9154
Practice Address - Street 1:1235 MAGNOLIA PARK CIR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-985-4257
Practice Address - Fax:770-985-4258
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2021-02-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist