Provider Demographics
NPI:1578347761
Name:PIERCE, ROGER JEROME JR (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:JEROME
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
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Mailing Address - Street 1:427 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2172
Mailing Address - Country:US
Mailing Address - Phone:229-319-9491
Mailing Address - Fax:
Practice Address - Street 1:615 S HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5556
Practice Address - Country:US
Practice Address - Phone:229-226-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028181363LF0000X
GARN212934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily