Provider Demographics
NPI:1689765687
Name:ROGERS, THEUS WESLEY JR (DC/PSY)
Entity Type:Individual
Prefix:DR
First Name:THEUS
Middle Name:WESLEY
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:DC/PSY
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 9793
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9793
Mailing Address - Country:US
Mailing Address - Phone:706-321-9800
Mailing Address - Fax:706-321-8284
Practice Address - Street 1:1240 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2538
Practice Address - Country:US
Practice Address - Phone:706-321-9800
Practice Address - Fax:706-321-8284
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional