Provider Demographics
NPI:1851439210
Name:ROGERS, MARCIA HAGER (EDS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:HAGER
Last Name:ROGERS
Suffix:
Gender:F
Credentials:EDS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 HAYNES CV
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8283
Mailing Address - Country:US
Mailing Address - Phone:404-376-3920
Mailing Address - Fax:
Practice Address - Street 1:814 MIMOSA BLVD
Practice Address - Street 2:BLDG. C
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4410
Practice Address - Country:US
Practice Address - Phone:770-261-1783
Practice Address - Fax:770-650-2996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist