Provider Demographics
NPI:1790235968
Name:THEUS W ROGERS PC
Entity Type:Organization
Organization Name:THEUS W ROGERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEUS
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-321-9800
Mailing Address - Street 1:1240 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2538
Mailing Address - Country:US
Mailing Address - Phone:706-321-9800
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty