Provider Demographics
NPI:1649237744
Name:ROGERS, GEORGE W JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:502 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3717
Mailing Address - Country:US
Mailing Address - Phone:859-331-3292
Mailing Address - Fax:859-578-2864
Practice Address - Street 1:19 E PIKE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2442
Practice Address - Country:US
Practice Address - Phone:859-491-1348
Practice Address - Fax:859-491-7174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY0238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR36897Medicare UPIN