Provider Demographics
NPI:1609875673
Name:ROGERS, GREGORY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:ROGERS
Suffix:
Gender:M
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:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0836
Mailing Address - Country:US
Mailing Address - Phone:706-252-8117
Mailing Address - Fax:
Practice Address - Street 1:909 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2706
Practice Address - Country:US
Practice Address - Phone:706-252-8117
Practice Address - Fax:706-252-8118
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000349533EMedicaid
C73990Medicare UPIN
GA202I111095Medicare PIN