Provider Demographics
NPI:1417127424
Name:ROGERS, MARQUETTE
Entity Type:Individual
Prefix:MR
First Name:MARQUETTE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-3611
Mailing Address - Country:US
Mailing Address - Phone:662-256-4334
Mailing Address - Fax:
Practice Address - Street 1:216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-1148
Practice Address - Country:US
Practice Address - Phone:662-862-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health