Provider Demographics
NPI:1649708090
Name:ROGERS, JESSE EDWARD III (PA-C)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:EDWARD
Last Name:ROGERS
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:195 PEACHBELT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4076
Mailing Address - Country:US
Mailing Address - Phone:706-975-7589
Mailing Address - Fax:
Practice Address - Street 1:801 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3426
Practice Address - Country:US
Practice Address - Phone:706-647-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant