Provider Demographics
NPI:1639833247
Name:ROGERS, LEIGH JAMES
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:JAMES
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1103
Mailing Address - Country:US
Mailing Address - Phone:912-704-4648
Mailing Address - Fax:
Practice Address - Street 1:2 MARSHLAND RD STE 6
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2305
Practice Address - Country:US
Practice Address - Phone:843-842-6357
Practice Address - Fax:843-842-6352
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily