Provider Demographics
NPI:1629058573
Name:ROGERS, WILLIAM EVAN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EVAN
Last Name:ROGERS
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:119 AMBULANCE DR 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:705 DIXIE STREET
Practice Address - Street 2:STE 401
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-836-9326
Practice Address - Fax:770-836-9358
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-08-04
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Provider Licenses
StateLicense IDTaxonomies
GA022041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0024769584Medicaid
AL009402230Medicaid
D42092Medicare UPIN