Provider Demographics
NPI:1417396342
Name:ROGERS, JOI LIVINGSTON (MD)
Entity Type:Individual
Prefix:
First Name:JOI
Middle Name:LIVINGSTON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WARD ST EXT W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 REGENCY PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7076
Practice Address - Country:US
Practice Address - Phone:770-957-8626
Practice Address - Fax:770-957-7200
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166378BMedicaid
GA075881OtherMEDICAL LICENSE