Provider Demographics
NPI:1629834320
Name:ROGERS, EMILY JADE (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JADE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3346
Mailing Address - Country:US
Mailing Address - Phone:706-722-0705
Mailing Address - Fax:
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3346
Practice Address - Country:US
Practice Address - Phone:706-722-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN291629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner